Bilateral adrenal masses secondary to fungal infiltration in an immuno-competent host
We presented a 54 year old gentleman, non-diabetic or hypertensive, presented with chronic headache worse in the afternoon, associated with late afternoon lethargy, loss of weight and loss of appetitefor 2 months duration. At presentation he was hypotensive, hyponatremic with relative hyperkalem...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Malaysian Endocrine and Metabolic Society
2014
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| Subjects: | |
| Online Access: | http://irep.iium.edu.my/48112/ http://irep.iium.edu.my/48112/ http://irep.iium.edu.my/48112/6/PP-046.pdf |
| Summary: | We presented a 54 year old gentleman, non-diabetic or hypertensive,
presented with chronic headache worse in the afternoon, associated with
late afternoon lethargy, loss of weight and loss of appetitefor 2 months
duration. At presentation he was hypotensive, hyponatremic with relative
hyperkalemia and low normal blood sugar. Six a.m. cortisol was 160
mmol/L. His hypotension and hyponatremia resolved after administration
of intravenous hydrocortisone 100mg tid. Computed tomography (CT) of
the adrenalsrevealedbilateral adrenal masses measuring 6.2 cm (largest
diameter) on the left side and 5.0 cm on the right side (figure 1). CT guided
biopsy of the adrenal mass revealed the presence of necrotic tissue with
fungal bodies (figure 2 and figure 3). Retroviral screen was negative. On
further questioning, the patient had been nursing an owl and had been
handling its droppings 2 months prior to the onset of symptoms. This
case illustrates the rare occurrence of bilateral adrenal mass from fungal
infiltrationcausing adrenal insufficiency in an immuno-competent host with
possible zoonosis from an owl. |
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