タイトル無し
スポンサーリンク
概要
- 論文の詳細を見る
We report a case of Addison's disease caused by tuberculosis. Enlarged adrenal glands were demonstrated by a computed tomographic scan (CT scan). An open biopsy of the left adrenal gland was carried out. We also report 20 cases of Addison's disease seen in our hospital during 28 years.A 61-year-old man was admitted to our hospital because of general fatigue. The patient was well until February in 1981, when general fatigue and loss of appetite developed. After one month, pigmentation of oral cavity and lips, and a decrease in weight were ob-served. The blood pressure was 92/60 mmHg and the pulse rate 76 beats/m. No lymph-adenopathy was found. The hemoglobin was 10.7 g/dl. The erythrocyte sedimentation rate was 40 mm/h. The C-reactive protein was 3+. A skin test for tuberculin was positive. There were persistent elevations of the serum alkaline phosphatase and the serum asparate amninotransferase (SGOT). The serum sodium was 132 mmol and the potassium 5.2 mmol. The urine sodium and potassium were normal. The fasting glucose was 60 mg/100ml. An X-ray film of the chest disclosed the old scar of tuberculosis. The Cooms test, the microsome titer and the anti-adrenal-antibody were all negative. The serum fasting cortisol was 1.8 μg/dl, the aldosterone 50 pg/ml, the ACTH 467 Pg/ml and the β-lipotropine 3259 pg/ml. The rapid ACTH test and the long ACTH test showed no response. Adrenal scinti scan revealed no uptake by adrenal glands. A CT scan of the abdomen revealed enlargement of adrenal glands (no calcification). The anatomical diagnosis was the tuberculoma of the adrenal glands.Among 20 cases of Addison's disease seen in our hospital, 6 cases were due to tuberculosis. Two cases were due to adrenal atrophy diagnosed by autopsy associated with liver cirrhosis and old scar of pulmonary tuberculosis respectively. Metastasis of the stomach cancer to the adrenals was one case in which the right adrenal gland was completely invaded and the left adrenal gland was invaded almost in two-thirds of the gland. The liver, lungs, kidneys, and the abdominal aortic lymphnodes were also invaded. The long-term steroid therapy caused the adrenal insufficiency in 4 cases. Seven cases were agnogenic.Recently CT scan was developed. CT scan was capable of displaying the adrenal gland tumor as small as 1 cm in diameter. In cases of Addison's disease due to tuberculosis, adrenal glands were found definitely to be enlarged and the tuberculous process was always progressive until the glands were almost completely destroyed. In this case the adrenal glands were also almost thoroughly destroyed. Although the number of Addison's disease due to tuberculosis is decreased, we should pay attention to adrenal tuberculosis since the long-term steroid therapy, dialysis, and diabetes mellitus are increased.
- 一般社団法人 国立医療学会の論文
一般社団法人 国立医療学会 | 論文
- An evaluation of interferon .ALPHA. in a few diseases during childhood.
- A Case of the Meckel's Diverticulum
- Studies on respiratory failure in pulmonary tuberculosis. (The second report). Exercise test.:-Exercise Test-
- The total lung function in bronchial asthma. 2. The lung function in steroid dependent bronchial asthma.:2. THE LUNG FUNCTION IN STEROID DEPENDENT BRONCHIAL ASTHMA
- 2. CURRENT STATE OF DIALYSIS MEDICAL CARE IN JAPAN: DIALYSIS THERAPY IN JAPAN: AN OVERVIEW