Case Report
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 6, 2024; 12(1): 217-223
Published online Jan 6, 2024. doi: 10.12998/wjcc.v12.i1.217
Addison's disease caused by adrenal tuberculosis may lead to misdiagnosis of major depressive disorder: A case report
Tian-Xiang Zhang, Hong-Yan Xu, Wei Ma, Jian-Bao Zheng
Tian-Xiang Zhang, Hong-Yan Xu, Wei Ma, Jian-Bao Zheng, Department of Tuberculosis, The Tuberculosis Hospital of Shaanxi Province, Xi’an 710100, Shaanxi Province, China
Jian-Bao Zheng, Department of General Surgery, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
Co-first authors: Tian-Xiang Zhang and Hong-Yan Xu.
Author contributions: Xu HY and Zhang TX discussed the patient and formulated the treatment plan; Zhang TX provided patient information and wrote the manuscript; Ma W contributed to the data analysis; Zheng JB contributed to conceptualization and supervision; all authors have read and agreed to the published version of the manuscript. Zhang TX and Xu HY contributed equally to this work as co-first authors. This article is the result of the joint efforts of researchers, and designating a collaborative work represents recognition of authors who have made similar contributions to this study, acknowledging the spirit of teamwork in this study. During patient diagnosis, treatment, and follow-up, different fields of knowledge enrich the discussion section of the article, improve the quality of the manuscript, and take the research to a deeper level, allowing readers to understand more disease-related knowledge while reading. In the process of writing an article, different writing techniques such as creating charts and photographs can help improve the content and make the article more comprehensive. We believe that Zhang TX and Xu HY are suitable as co-first authors of our manuscript, providing deeper content, making the article more comprehensive, and reflecting the equal contribution and importance of teamwork.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Jian-Bao Zheng, PhD, Professor, Department of Tuberculosis, The Tuberculosis Hospital of Shaanxi Province, No. 1 Jiazi, Shangwan Village, Taiyigong Town, Xi’an 710100, Shaanxi Province, China. jacke6071@163.com
Received: October 30, 2023
Peer-review started: October 30, 2023
First decision: November 21, 2023
Revised: November 30, 2023
Accepted: December 19, 2023
Article in press: December 19, 2023
Published online: January 6, 2024
Processing time: 63 Days and 15.9 Hours
Abstract
BACKGROUND

Addison’s disease (AD) is a rare but potentially fatal disease in Western countries, which can easily be misdiagnosed at an early stage. Severe adrenal tuberculosis (TB) may lead to depression in patients.

CASE SUMMARY

We report a case of primary adrenal insufficiency secondary to adrenal TB with TB in the lungs and skin in a 48-year-old woman. The patient was misdiagnosed with depression because of her depressed mood. She had hyperpigmentation of the skin, nails, mouth, and lips. The final diagnosis was adrenal TB that resulted in the insufficient secretion of adrenocortical hormone. Adrenocortical hormone test, skin biopsy, T cell spot test of TB, and adrenal computed tomography scan were used to confirm the diagnosis. The patient’s condition improved after hormone replacement therapy and TB treatment.

CONCLUSION

Given the current status of TB in high-burden countries, outpatient doctors should be aware of and pay attention to TB and understand the early symptoms of AD.

Keywords: Primary adrenal insufficiency; Adrenal tuberculosis; Fatigue; Hypotension; Hyperkalemia; Hyponatremia; Depression; Case report

Core Tip: Symptoms of early-onset depressed mood and skin pigmentation in developing countries warrant consideration for Addison’s disease (AD) induced by adrenal tuberculosis (TB) Diagnostic anti-TB therapy with rifampicin is not recommended because of the risk of adrenal crisis; T cell spot test of TB negativity cannot be used as a criterion to exclude TB, especially in immunocompromised patients or those with hematogenous disseminated pulmonary TB; In AD caused by adrenal TB, recovering adrenal function is difficult, with most cases requiring lifelong hormone replacement therapy.