Miliary Tuberculosis Causing Presumed Primary Adrenal Insufficiency and Addisonian Crisis: A Case Report from Rural Kenya

Authors

  • Vonwicks C. Onyango Department of Medicine, St. Joseph Rift Valley Hospital, Gilgil, Nakuru County, Kenya
  • Boniface Mutiso Department of Outpatient, St. Joseph Rift Valley Hospital, Gilgil, Nakuru County, Kenya
  • Nicholas M. Mutuma Department of Outpatient, St. Joseph Rift Valley Hospital, Gilgil, Nakuru County, Kenya
  • Collins P. Malalu Department of Outpatient, St. Joseph Rift Valley Hospital, Gilgil, Nakuru County, Kenya
  • Nicholas Auma Department of Endoscopy, St. Joseph Rift Valley Hospital, Gilgil, Nakuru County, Keny
  • William C. Fryda MD Department of Medicine, St. Joseph Rift Valley Hospital, Gilgil, Nakuru County

DOI:

https://doi.org/10.54536/ajmsi.v3i1.2773

Keywords:

Primary Adrenal Insufficiency, Addison’s Disease, Adrenal Crisis, Addisonian Crisis, Miliary Tuberculosis, Tuberculous Adrenal Insufficiency, Glucocorticoid, Kenya

Abstract

Primary adrenal insufficiency (Addison’s disease) is characterized by inadequate production of cortisol from the adrenal glands due to diseases of the adrenal gland. Due to the insidious onset and non-specific nature of the symptoms of adrenal insufficiency, diagnosis is often delayed until patients present with an adrenal crisis. The three most common causes are autoimmune adrenalitis, infections, e.g., disseminated tuberculosis, HIV, systemic mycoses, and adrenal hemorrhage or infarction. Miliary tuberculosis of the adrenal gland occurs in high-TB burden populations by hematogenous spread of tuberculous bacilli to the gland, causing caseous necrosis, or by extra-adrenal infection and rifampicin-induced adrenal insufficiency. In this study, we report on the case of a middle-aged woman in rural Kenya who initially presented with missed features of adrenal insufficiency and subsequently went into an adrenal (Addisonian) crisis, which was successfully managed with glucocorticoids, fluids, and supportive therapy.

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Author Biographies

Vonwicks C. Onyango, Department of Medicine, St. Joseph Rift Valley Hospital, Gilgil, Nakuru County, Kenya

Consultant Physician, Department of Medicine, St. Joseph Rift Valley Hospital, Gilgil, Nakuru County

Boniface Mutiso, Department of Outpatient, St. Joseph Rift Valley Hospital, Gilgil, Nakuru County, Kenya

Senior Clinical Officer, St. Joseph Rift Valley Hospital, Gilgil, Nakuru County, Kenya.

Collins P. Malalu, Department of Outpatient, St. Joseph Rift Valley Hospital, Gilgil, Nakuru County, Kenya

Medical Officer (Intern), St. Joseph Rift Valley Hospital, Gilgil, Nakuru County, Kenya

William C. Fryda MD, Department of Medicine, St. Joseph Rift Valley Hospital, Gilgil, Nakuru County

Chief Physician, St. Joseph Rift Valley Hospital, Gilgil, Nakuru County, Kenya

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Published

2024-05-14

How to Cite

Onyango, V. C., Mutiso, B., Mutuma, N. M., Malalu, C. P., Auma, N., & Fryda MD, W. C. (2024). Miliary Tuberculosis Causing Presumed Primary Adrenal Insufficiency and Addisonian Crisis: A Case Report from Rural Kenya. American Journal of Medical Science and Innovation, 3(1), 91–95. https://doi.org/10.54536/ajmsi.v3i1.2773