Adrenal Histoplasmosis Manifested as Addison’s Disease: Unusual CT Features with Magnetic Resonance Imaging Correlation

Rozenblit, Alla M.; Kim, Andrew; Tuvia, Joseph; Wenig, Bruce M.

doi:10.1053/crad.2000.0713

Cited by 29 publications

(22 citation statements)

References 7 publications

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“…15 Clinical manifestations include chronic fatigue, weight loss, anorexia and fever of variable duration. [16][17][18] However, adrenal insufficiency is uncommon. 19 We also encountered adrenal insufficiency in one among ten patients with adrenal histoplasmosis.…”

Section: Discussionmentioning

confidence: 99%

Adrenal histoplasmosis diagnosed by endoscopic ultrasound guided fine needle aspiration: experience of 10 patients

Singh¹

2017

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Background:There have been sporadic reports of histoplasmosis from India. Although traditionally considered a disease of immunocompromised hosts, immunocompetent patients presenting with adrenal histoplasmosis have been reported. Endoscopic ultrasound (EUS) provides easy and safe approach to adrenal glands for fine needle aspiration. Methods: We report 10 cases of adrenal histoplasmosis diagnosed by endoscopic ultrasound (EUS) guided FNA. The mean age at diagnosis was 54 ± 9 years, all were males. Eight patients were immunocompetent while two had cirrhosis; none of them was retrovirus positive. All patients presented with fever and weight loss, 8 had bilateral adrenal enlargement while 2 had isolated left adrenal enlargement. EUS features included hypoechoic (30%) or heteroechoic (70%) adrenal glands, presence of hypoechoic areas suggestive of necrosis within the gland was identified in 40% of these patients. Adrenal insufficiency was present in 1 patient (10%) which persisted even after successful treatment. Conclusion: Adrenal histoplasmosis should be considered even in immunocompetent hosts presenting with constitutional symptoms and adrenal enlargement. EUS guided FNA is a safe and accurate modality for adrenal sampling.

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Section: Discussionmentioning

confidence: 99%

Adrenal histoplasmosis diagnosed by endoscopic ultrasound guided fine needle aspiration: experience of 10 patients

Singh¹

2017

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“…On ultrasonography, they may show uniformly hypoechoic to heterogenous echopattern. Bilateral symmetrical adrenomegaly with preservation of the contour of the gland, central hypodensity with peripheral enhancement and presence of calcification has been described in CT.[6]…”

Section: Discussionmentioning

confidence: 99%

“…The differential diagnoses of bilateral adrenomegaly are metastasis, lymphoma, adrenal haemorrhage, sarcoidosis and infections which include histoplasmosis, tuberculosis, cryptococosis, coccidioidomycosis and blastomycosis. [67] But, central hypodensity and peripheral rim enhancement of the adrenals narrow down the differentials only to tuberculosis and histoplasmosis. [8] As the adrenal gland is frequently the only demonstrable site of active disease, adrenal FNAC can suggest the diagnosis which is further confirmed by culture, polymerase chain reaction, and urine antigen.…”

Section: Discussionmentioning

confidence: 99%

Adrenal histoplasmosis: An unusual cause of adrenomegaly

et al. 2011

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Histoplasmosis is a geographically restricted form of fungal infection. Adrenal involvement is seen in disseminated disease but sometimes it may be the only site of demonstrable disease. Early diagnosis and treatment may save the patient from catastrophic adrenal insufficiency. We present two patients showing bilateral adrenomegaly on ultrasonography and contrast-enhanced CT, and was diagnosed to have histoplasmosis on fine-needle aspiration cytology.

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“…Typically, it includes bilateral adrenal masses with peripheral enhancement and central hypodensities, with calcification seen in the healing phase. [9] These changes are usually bilateral and symmetrical and the shape of adrenal gland is usually preserved.…”

Section: Discussionmentioning

confidence: 99%

Persistence of histoplasma in adrenals 7 years after antifungal therapy

Kothari¹,

Chopra²,

Bhardwaj³

et al. 2013

Indian J Endocr Metab

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Adrenal histoplasmosis is an uncommon cause for adrenal insufficiency. The duration of treatment for adrenal histoplasmosis is not clear. Existing treatment regimens advocate antifungals given for periods ranging from 6 months to 2 years. We report here a rare case who showed persistence of histoplasma in adrenal biopsy 7 years after being initially treated with itraconazole for 9 months. This calls for a prolonged therapy with regular review of adrenal morphology and histology in these patients.

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Adrenal Histoplasmosis Manifested as Addison’s Disease: Unusual CT Features with Magnetic Resonance Imaging Correlation

Cited by 29 publications

References 7 publications

Adrenal histoplasmosis diagnosed by endoscopic ultrasound guided fine needle aspiration: experience of 10 patients

Adrenal histoplasmosis diagnosed by endoscopic ultrasound guided fine needle aspiration: experience of 10 patients

Adrenal histoplasmosis: An unusual cause of adrenomegaly

Persistence of histoplasma in adrenals 7 years after antifungal therapy

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