ABSTRACT
BACKGROUND: The aim of this study was to evaluate adrenal gland morphology by computerized tomography (CT) in the etiologic diagnosis of Addison's disease. METHODS: Twenty-two patients were grouped according to their etiology based on the study of antiadrenal antibodies at diagnosis of the disease: 7 were positive (autoimmune etiology or EAA), 11 were negative (tuberculous etiology or EAT) and in four serologic study was not available (undetermined etiology or EAI). Adrenal gland CT was performed with contiguous sections every 5 mm. In eight cases the examination was carried out upon diagnosis of the disease (initial stage) and in 14 between 2 and 17 years following diagnosis (evolutive stage). RESULTS: In all the patients of the EAA group, examined in either the initial or evolutive stages, the adrenal glands appeared atrophic without calcifications. In the patients of the EAT group adrenal masses of proven tuberculous origin were found in five who were studied in the initial stage and with atrophic glands with calcifications in the remaining patients examined in the evolutive stage, with the exception of two cases with atrophic adrenal glands without calcifications which could serologically be considered as false negatives having autoimmune etiology. The patients in the EAI groups were studied in the evolutive stage with three having atrophic glands with calcifications and one atrophic adrenal glands without calcifications. CONCLUSIONS: Adrenal gland computerized tomography is an useful examination to differentiate between autoimmune or tuberculous origin in Addison's disease. Clinical application may be justified in all patients of recent diagnosis when the study of the antiadrenal antibodies is negative or not possible.
Subject(s)
Addison Disease/diagnostic imaging , Adrenal Glands/diagnostic imaging , Tomography, X-Ray Computed , Addison Disease/blood , Addison Disease/complications , Addison Disease/etiology , Adolescent , Adrenal Gland Diseases/diagnostic imaging , Adrenal Gland Diseases/etiology , Adrenal Glands/immunology , Adult , Aged , Autoantibodies/blood , Calcinosis/diagnostic imaging , Calcinosis/etiology , Female , Humans , Male , Middle AgedSubject(s)
Fever/diagnosis , Syphilis/diagnosis , Female , Humans , Middle Aged , Syndrome , Time FactorsABSTRACT
We present the clinical-epidemiological results obtained in a series of 45 patients diagnosed of Addison disease between 1967 and 1988. The incidence was 0.83 cases/100,000 inhabitants/year and the prevalence was 10 cases/100,000 inhabitants. The etiology was unknown in 44.4% of cases tuberculous in 24.4% and in 31.1% of cases the caused could not be established with the classical clinical and radiological criteria. Amongst the studied variables in each etiological group, we highlight the association with other autoimmune processes and the development of extraadrenal tuberculous infection after Addison disease diagnosis. We discuss the approach to etiological diagnosis and the convenience of tuberculostatic treatment in EAT cases.
Subject(s)
Addison Disease/epidemiology , Addison Disease/etiology , Tuberculosis/complications , Adult , Female , Humans , Incidence , Male , Middle Aged , Prevalence , Retrospective Studies , Spain/epidemiologyABSTRACT
We present the clinical case of a patient affected of Hashimoto thyroiditis who after suffering hypothyroidism for 11 years developed Grave's disease with hyperthyroidism. This is a very rare evolution of the autoimmune thyroid disease. We discuss the possible etiopathogenesis with a literature review.
