Primary Adrenal Insufficiency Caused by Disseminated Histoplasmosis: Report of Two Cases

Histoplasmosis and penicilliosis: Comparison of clinical features, laboratory findings and outcome

“…However, abdominal pain was more common in the latter whereas hypotension and lymphadenopathy were more common in the former. Adrenal gland involvement was occasionally reported in histoplasmosis 1,9,10 and might have caused hypotension in some of the reported cases.…”

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

“…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.…”

Adrenal infections

“…65 H. capsulatum adrenal lesions are found most commonly in the zona reticularis where there are elevated levels of corticoids downstream from the area of secretion, zona fasciculata to the medullary venous system. 15,65 The development of adrenal vasculitis can cause extensive glandular destruction resulting in frank adrenal insufficiency. 66 As in P. brasiliensis, the affected vessels are unable to adequately perfuse adrenal tissue, leading to caseation necrosis and massive glandular infarction.…”

“…However, numerous case reports describe individuals with objectively normal immune function who nonetheless have clinical or pathological evidence of primary adrenal involvement in the setting of an indolent infection. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Due to the non-specific nature of the symptomatology and laboratory manifestations (e.g., fatigue, anorexia, low blood pressure, hyperkalemia, hypernatremia, hypoglycemia 1 ) and the fact that 80-90% of the gland must be destroyed before the patient will demonstrate overt Addisonian symptoms, 17 antemortem diagnosis is rare. However, prompt recognition combined with appropriate therapy early in the disease course may prove beneficial, 13,15,16,[18][19][20] thereby warranting a high clinical suspicion for adrenal involvement in the appropriate clinical scenario.…”

“…Adrenal dysfunction can also occur in response to infections at distant sites or in disseminated disease due to alterations in the host's physiochemical milieu. [14][15][16][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] It is generally understood that individuals who are responding to the stress of an illness (e.g., a systemic infection) will manifest an increase in the functioning of the hypothalamopituitary-adrenal axis (HPA-axis) leading to an overall increase in systemic corticosteroid levels. Increased cortisol secretion has been shown to shift the balance in the Th1/Th2 cell ratio towards a Th2 response.…”