A Case Series Of Primary Adrenal Insufficiency Of Infectious Etiology (Tuberculous Adrenalitis) Presenting As Gastrointestinal, Systemic And Cutaneous Manifestations -A Single Center Experience From Andhra Pradesh

Addison's disease presents with chronic and progressive fatigue, muscle weakness, lightheadedness with gastrointestinal symptoms (nausea, diarrhea, vomiting, and weight loss) and hypotension and hyperpigmentation with lab abnormalities such as hyponatremia and hyperkalemia with normal anion gap metabolic acidosis with low cortisol and raised ACTH, that even after receiving cosyntropin stays low. The most common etiologies are autoimmune adrenalitis in developed countries and TB in developing countries. We present a case series of 2 different case reports with various manifestations of primary adrenal insufficiency of infectious etiology(extrapulmonary tuberculosis). The importance lies in the fact that extrapulmonary TB can present with a wide range of symptoms mimicking other diseases. Primary adrenal insufficiency is rare but one such presentation often leading to late diagnosis increasing morbidity and mortality. This case series highlights the importance of considering TB as one of the differential diagnoses for unexplained adrenal insufficiency even in the absence of a history of tuberculosis.