Case Report: Adrenal tuberculosis causing primary adrenal insufficiency: diagnosis by ultrasound-guided biopsy

Adrenal tuberculosis, though a rare extrapulmonary manifestation of <i>Mycobacterium tuberculosis</i> infection, remains a significant etiology of primary adrenal insufficiency in tuberculosis-endemic regions. We present a case of a 38-year-old asymptomatic female patient incidentally found to have bilateral adrenal nodules with calcifications during routine health screening. Laboratory tests revealed significantly elevated adrenocorticotropic hormone levels and low plasma cortisol, while imaging studies showed bilateral adrenal masses. Despite anatomically challenging access, an ultrasound-guided core needle biopsy was successfully performed. Histopathological analysis identified caseating granulomatous inflammation, and the positive T-SPOT. TB assay confirmed the diagnosis of adrenal tuberculosis. This case illustrates an innovative biopsy approach for anatomically complex adrenal lesions, underscoring the diagnostic utility of image-guided techniques in rare adrenal disorders.