case of disseminated tuberculosis with adrenal insufficiency

We present the case of a 37 year-old female who had disseminated tuberculosis [TB] with bilateral adrenal involvement resulting in primary adrenal failure [Addison's disease] with refractory hyponatraemia and possible extrapontine 'myelinolysis'. Laboratory results were remarkable for adrenal insufficiency. A Mantoux reaction was positive with evidence of pulmonary miliary TB. The magnetic resonance imaging scan showed all the characteristic changes of adrenal TB