Subject(s)
Breast Diseases/etiology , Breast Implants , Prosthesis-Related Infections/etiology , Tuberculosis, Endocrine/etiology , Adult , Antitubercular Agents/therapeutic use , Breast Diseases/drug therapy , Device Removal , Drug Combinations , Female , Humans , Mycobacterium tuberculosis , Pleural Effusion/etiology , Prosthesis-Related Infections/drug therapy , Silicone Gels , Treatment Refusal , Tuberculosis, Endocrine/drug therapy , Tuberculosis, Pulmonary/drug therapyABSTRACT
OBJECTIVES: To raise awareness of hypercalcemia as a rare and at times inaugural manifestation of adrenal insufficiency. CASE REPORT: Evaluation of hypercalcemia in a 43-year-old man showed adrenal insufficiency. Biopsies of the testes and adrenal glands revealed epithelioid and giant cell lesions indicating tuberculosis. Although tuberculosis can contribute to hypercalcemia, this possibility was ruled out in our patient by the low serum 1,25-dihydroxy-vitamin D3 levels and return to normal of serum calcium and renal function under hormone replacement therapy. It should be noted, however, that a course of pamidronate was given. CONCLUSION: The mechanism of hypercalcemia associated with adrenal insufficiency is controversial. Hyperparathyroidism was ruled out in our patient. Adrenal insufficiency should be considered in some patients with hypercalcemia.
Subject(s)
Adrenal Insufficiency/pathology , Hypercalcemia/pathology , Tuberculosis, Endocrine/pathology , Adrenal Insufficiency/blood , Adrenal Insufficiency/complications , Adult , Antitubercular Agents/therapeutic use , Calcitriol/blood , Drug Therapy, Combination , Fludrocortisone/therapeutic use , Hormone Replacement Therapy , Humans , Hydrocortisone/therapeutic use , Hypercalcemia/blood , Hypercalcemia/etiology , Male , Treatment Outcome , Tuberculosis, Endocrine/complications , Tuberculosis, Endocrine/etiologyABSTRACT
Intrasellar infection is characterized by pituitary dysfunction and damage to surrounding structures. In most cases patients have fever, headache, and visual disturbance and exhibit roentgenographic evidence of a mass. Suppurative infections may originate in the paranasal sinuses, meninges, or more distant foci and are commonest in the setting of preexisting pituitary adenomata. Pituitary tuberculosis may arise from hematogenous spread or extension of local lesions and may be confused with a variety of other granulomatous diseases. Congenital and acquired syphilis of the pituitary are more often diagnosed at autopsy or by the concurrence of pituitary dysfunction and serologic evidence of syphilis. Although viral infection may be associated with pituitary or hypothalamic dysfunction, overt hypophyseal infection is rarely documented. In contrast, a variety of parasites and fungi have been found in pituitary tissue. The diagnosis of pituitary infection should be considered when signs of intrasellar mass or pituitary dysfunction are accompanied by fever and other evidence of infection.
