S. Rickes, A. Rudiger, H. Lochs, W. Wermke

A 32-year old Pakistani patient came with exhaustion, nausea and vomiting into stationary reception. There was a hyper-pigmentation of the body with a predilection for the navel and the folds of the hands. On a clinical basis the provisional diagnosis of Morbus Addison was established. This was confirmed by laboratory tests of low cortisol and high ACTH in the plasma.

Sonographically (Pictures 1a and 1b) and by means of computer tomography (Picture 2) calcifications in the adrenal region

were displayed. On the basis of the prior history of histologically confirmed open tuberculosis of the lungs four years previously, we interpreted the calcification of the adrenals as due to tuberculosis. Under hydrocortisone therapy the symptoms rapidly abated.

With this case report therefore attention should be directed to the idea that one should consider the existence of an adrenal tuberculosis in patients with Morbus Addison who come from regions of tuberculosis epidemic. Sonography is thereby, alongside the other imaging methods, suited to diagnosis.