In September 2018, one 55-year-old female from Satna, MP was admitted in Nagpur based Orange City Hospital & Research Institute a unit of Ravi Nair Hospitals Private Limited under care of Dr. Vina Bang- OCHRI Physician. She presented with vague symptoms of vomiting, generalized weakness, weight loss, appetite loss, hyper pigmentation and low grade fever. She was evaluated extensively. All possible causes were ruled out. Clinically she had all signs of adrenal insufficiency so imaging was done with special focus on both adrenals. She had granulomatous lesion in Lt. Adrenal Glands leading to its size up to 3 to 4 times the normal size. Rt. Adrenal Gland was also enlarged. Her Monteux test was positive and ESR was raised. She was started on ATT (Anti Tubercular Treatment) after counselling and explaining to patient & relatives about nature and course of disease. She was discharged in couple of days and they continued treatment and followed up in OPD since then. Before coming to OCHRI; she had been taken to many private hospitals where she was evaluated but no confirmed diagnosis was made. Because of all these medical problems she also suffered from depression and was also being treated by Psychiatrist.
In first two months; patient showed very slow recovery. Her fever subsided. But she had persistent hypoglycemia, postural hypotension, hyper pigmentation and there was no weight gain also, which were suggestive of Adrenal Insufficiency. So Dr. Vina Bang started steroids along with ATT.
Dr. Vina Bang informed that, “Recently, she completed her ATT with good compliance to treatment. Gradually steroids were also tapered off. Now since 3 months she is off steroids. Her repeat scan showed resolution in adrenal lesion and reduction in size of Glands. She has gained weight significantly from 44 kg to now 64 kg. There is no further episode of fever in last 1 year. Her appetite has improved and pigmentation has also faded. The most important outcome is patient is very happy.
Dr. Nishikant Lokhande- OCHRI Radiologist mentioned that adrenal tuberculosis can result in a life-threatening disorder called primary adrenal insufficiency (PAI) due to the destruction of adrenal cortex. CT forms the mainstay of evaluation due to its high spatial resolution and availability, but MRI also has a known role in assessing adrenal lesions, particularly in young patients where radiation dose is a concern.
Dr. Anup Marar- OCHRI Director added that corticosteroids should be used cautiously with antitubercular therapy in view of drug interaction seen between them. In cases of adrenal crisis, corticosteroid replacement becomes mandatory. The comprehensive methodical assessment undertaken by Dr. Vina Bang before initiating both treatment protocols is appreciable.
Dr. Usha Nair- RNHPL Director complimented Dr. Vina Bang for the detailed intricate evaluation which helped her to clinch the diagnosis and provide solace to this MP patient who reached OCHRI as last hope. She added that it is total faith of relatives on treating team which gives them liberty to think out of box and treat the patient successfully.
Relatives of said patient thanked Dr. Vina Bang and TEAM OCHRI for successful treatment of their patient.