요근농양과 십이지장누공을 동반한 부신결핵에 의한 애디슨병 1예
Addison Disease Due to Adrenal Tuberculosis Presenting as an Abscess in a Nearby Psoas Muscle with a Duodenal Fistula
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초록
일차성 부신기능부전(primary adrenal insufficiency; Addison disease)은 전 세계적으로 드문 질환으로 자가면역 기전에 기인한 경우가 대부분을 차지하는 것으로 알려져 있다[1]. HIV 감염에 의해 면역이 저하된 환자에게 나타날 수 있는 거대세포바이러스(cytomegalovirus) 또는 결핵균에 의한 부신피질기능의 손상은, 애디슨병의 두 번째 호발 원인으로 알려져 있는데, 특히 결핵균의 부신 침윤은 개발도상국 또는 결핵 유행지역에서 일차성 부신기능부전의 20-50%를 차지한다[1,2].
Abstract
An 80-year-old male with nausea and poor oral intake was referred for evaluation of hyponatremia. Primary adrenal insufficiency was diagnosed by a rapid adrenocorticotropic hormone (ACTH) stimulation test. The cause of the adrenal insufficiency was revealed to be adrenal tuberculosis presenting as a bilateral adrenal mass on computed tomography imaging. During the first few months of treatment, the size of the tuberculous mass increased and spread to an adjacent area, and further adrenal hormone replacement was needed. In addition, there was a newly developed tuberculous abscess in a nearby psoas muscle with a duodenal fistula. Thus, we report a case of a long-term clinical course of Addison’s disease with changes in hormone replacement as a result of active adrenal tuberculosis, together with a review of the literature.
참고문헌 (10)
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