ABSTRACT
Background: Some observational studies and clinical experiments suggest a close association between gut microbiota and metabolic diseases. However, the causal effects of gut microbiota on adrenal diseases, including Adrenocortical insufficiency, Cushing syndrome, and Hyperaldosteronism, remain unclear. Methods: This study conducted a two-sample Mendelian randomization analysis using summary statistics data of gut microbiota from a large-scale genome-wide association study conducted by the MiBioGen Consortium. Summary statistics data for the three adrenal diseases were obtained from the FinnGen study. The study employed Inverse variance weighting, MR-Egger, and MR-PRESSO methods to assess the causal relationship between gut microbiota and these three adrenal diseases. Additionally, a reverse Mendelian randomization analysis was performed for bacteria found to have a causal relationship with these three adrenal diseases in the forward Mendelian randomization analysis. Cochran's Q statistic was used to test for heterogeneity of instrumental variables. Results: The IVW test results demonstrate that class Deltaproteobacteria, Family Desulfovibrionaceae, and Order Desulfovibrionales exhibit protective effects against adrenocortical insufficiency. Conversely, Family Porphyromonadaceae, Genus Lachnoclostridium, and Order MollicutesRF9 are associated with an increased risk of adrenocortical insufficiency. Additionally, Family Acidaminococcaceae confers a certain level of protection against Cushing syndrome. In contrast, Class Methanobacteria, Family Lactobacillaceae, Family Methanobacteriaceae, Genus. Lactobacillus and Order Methanobacteriales are protective against Hyperaldosteronism. Conversely, Genus Parasutterella, Genus Peptococcus, and Genus Veillonella are identified as risk factors for Hyperaldosteronism. Conclusions: This two-sample Mendelian randomization analysis revealed a causal relationship between microbial taxa such as Deltaproteobacteria and Desulfovibrionaceae and Adrenocortical insufficiency, Cushing syndrome, and Hyperaldosteronism. These findings offer new avenues for comprehending the development of adrenal diseases mediated by gut microbiota.
Subject(s)
Gastrointestinal Microbiome , Genome-Wide Association Study , Mendelian Randomization Analysis , Humans , Gastrointestinal Microbiome/genetics , Adrenal Gland Diseases/microbiology , Adrenal Gland Diseases/genetics , Bacteria/classification , Bacteria/genetics , Bacteria/isolation & purification , Hyperaldosteronism/genetics , Hyperaldosteronism/microbiology , Cushing Syndrome/microbiology , Cushing Syndrome/genetics , Adrenal Insufficiency/microbiologySubject(s)
Adrenal Gland Diseases , Adrenal Insufficiency , Histoplasmosis , Humans , Adrenal Gland Diseases/diagnostic imaging , Adrenal Gland Diseases/microbiology , Adrenal Insufficiency/diagnostic imaging , Adrenal Insufficiency/etiology , Adrenal Insufficiency/microbiology , Histoplasmosis/complications , Histoplasmosis/diagnosis , Histoplasmosis/diagnostic imaging , Adrenal Glands/diagnostic imaging , Adrenal Glands/microbiologyABSTRACT
ABSTRACT: Cryptococcosis usually occurs in immunocompromised patients and presents as meningitis and lung disease. Adrenal gland involvement may be observed, yet primary adrenal insufficiency by cryptococcal infection is infrequent. We present a case of a middle-aged immunocompetent man with primary adrenal insufficiency and bilateral adrenal lesions, splenomegaly, and miliary mottling in the lungs on imaging. No evidence of meningitis was witnessed. The clinico-radiological findings led toward the differential diagnosis of disseminated tuberculosis or fungal infection. Detection of cryptococcus organism was done on fine-needle aspiration cytology and biopsy on periodic acid-Schiff stain and Gomori`s methenamine silver stain. Thus, it is recommended to keep the possibility of cryptococcosis in mind while dealing with instances that have a tuberculosis-like clinico-radiological presentation. The detection of the causal organism on Fine needle aspiration (FNA)/biopsy examination may be useful in confirming the diagnosis and determining the appropriate medical treatment.
Subject(s)
Adrenal Glands , Adrenal Insufficiency , Cryptococcosis , Humans , Male , Cryptococcosis/diagnosis , Cryptococcosis/drug therapy , Cryptococcosis/pathology , Biopsy, Fine-Needle , Adrenal Insufficiency/diagnosis , Middle Aged , Adrenal Glands/pathology , Adrenal Glands/diagnostic imaging , Adrenal Glands/microbiology , Cryptococcus/isolation & purification , Diagnosis, Differential , Tomography, X-Ray Computed , Lung/pathology , Lung/diagnostic imaging , Microscopy , Adrenal Gland Diseases/diagnosis , Adrenal Gland Diseases/microbiology , Immunocompetence , HistocytochemistrySubject(s)
Abscess/diagnosis , Adrenal Gland Diseases/diagnosis , Melioidosis/diagnosis , Abscess/drug therapy , Abscess/microbiology , Abscess/pathology , Adrenal Gland Diseases/drug therapy , Adrenal Gland Diseases/microbiology , Adrenal Gland Diseases/pathology , Aged , Anti-Bacterial Agents/therapeutic use , Humans , Male , Melioidosis/pathologySubject(s)
Abscess/surgery , Adrenal Gland Diseases/surgery , Adrenalectomy/methods , Bacteremia/surgery , Streptococcal Infections/surgery , Streptococcus pyogenes , Abscess/microbiology , Adrenal Gland Diseases/microbiology , Bacteremia/microbiology , Emergencies , Humans , Laparoscopy/methods , Male , Medical Illustration , Middle Aged , Streptococcal Infections/microbiologyABSTRACT
Primary adrenal insufficiency is a defect in glucocorticoid, mineralocorticoid and sexual androgens production. Patients with this disorder have low cortisol levels and aldosterone deficiency with concomitant hyponatremia and hyperkalemia. The most common etiology of this disease is the production of antibodies against the enzyme 21 hydroxylase. Another common cause, particularly in low income countries, are infectious diseases. Several micro-organisms have been reported as a causal agent in adrenal insufficiency including Mycobacterium tuberculosis, Mycobacterium avium complex, Neisseria meningitidis, Pseudomonas aeruginosa, Haemophilus influenzae, cytomegalovirus, Pneumocystis jirovecii, Histoplasma capsulatum, Blastomyces dermatiditis, Cryptococcus neoformans, Cocciodiodes immitis, Nocardia spp. and Paracoccidioides brasiliensis. In this article, we present the computerized tomography and the adrenal biopsy of a patient with adrenal insufficiency. The final diagnosis was paracoccidioidomycosis.
La insuficiencia suprarrenal primaria es un defecto en la producción de glucocorticoides, mineralocorticoides y andrógenos sexuales. Los pacientes afectados por esta condición se caracterizan por concentraciones bajas de cortisol y deficiencia de aldosterona con hiponatremia e hiperpotasemia concomitantes. La etiología más común es el desarrollo de anticuerpos contra la enzima 21 hidroxilasa. Otra causa importante de la insuficiencia suprarrenal primaria son las enfermedades infecciosas, en especial en los países de bajos ingresos. Entre las causas infecciosas que se han descrito se encuentran: Mycobacterium tuberculosis, el complejo de Mycobacterium avium, Neisseria meningitidis, Pseudomonas aeruginosa, Haemophilus influenzae, citomegalovirus, Pneumocystis jirovecii, Histoplasma capsulatum, Blastomyces dermatiditis, Cryptococcus neoformans, Cocciodiodes immitis, Nocardia spp. y Paracoccidioides brasiliensis. En este artículo se presenta la imagen de la tomografía de un paciente que presentó falla suprarrenal, con masas en las glándulas suprarrenales, cuya biopsia permitió establecer el diagnóstico final de paracoccidioidomicosis.
Subject(s)
Adrenal Gland Diseases/microbiology , Paracoccidioidomycosis , Adrenal Gland Diseases/diagnosis , Adrenal Gland Diseases/drug therapy , Adrenal Insufficiency/complications , Humans , Male , Middle Aged , Paracoccidioidomycosis/complications , Paracoccidioidomycosis/diagnosis , Paracoccidioidomycosis/drug therapyABSTRACT
Pneumocystis jirovecii (PJ) infection is one of the most common opportunistic infections occurring in patients with HIV/AIDS and other immunocompromised states. It is not known to cause clinically significant illness in immunocompetent hosts. We report a 48-year-old HIV-negative, diabetic male who presented with fever and adrenal insufficiency. Abdominal sonography and PET-CT revealed bilateral enlarged adrenal glands with peripheral enhancement and central necrosis. An endoscopic ultrasound-guided fine-needle aspiration cytology of the left adrenal gland demonstrated well-defined, round cysts of PJ. There was no evidence of pulmonary involvement. The response to first-line treatment was poor and the patient responded to second-line treatment for Pneumocystis infection.
Subject(s)
Adrenal Gland Diseases/diagnosis , Adrenal Gland Diseases/microbiology , Pneumocystis Infections/diagnosis , Pneumocystis carinii , Adrenal Gland Diseases/drug therapy , Adrenal Glands/diagnostic imaging , Adrenal Glands/microbiology , Adrenal Glands/pathology , Anti-Bacterial Agents/therapeutic use , Antimalarials/therapeutic use , Clindamycin/therapeutic use , Drug Therapy, Combination , Fever/microbiology , Humans , Immunocompetence , Male , Middle Aged , Muscle Weakness/microbiology , Pneumocystis Infections/drug therapy , Positron-Emission Tomography , Primaquine/therapeutic use , Weight LossABSTRACT
Isolated adrenal tuberculosis accounts for less than 2% of adrenal incidentalomas. This is the most frequent infectious cause of adrenal insufficiencies. We report the case of a 53-year old patient with no previous medical history presenting with adrenal insufficiency with slow progression over six months. Physical examination didn't show any mass or hepatosplenomegaly. Blood pressure was 120/60 mmHg. Laboratory tests didn't show inflammatory syndrome. LDH level was normal. CT scan showed bilateral hypertrophy of the adrenal glands characterized by calcifications. Intradermo tuberculin reaction was positive at 25mm. The analyses to detect Koch's bacillus in the sputum and in the urine were negative. Quantiferon® test was positive. Trial antibacillar treatment was started with clinical improvement and 5kg weight gain in 12 months. Hormonal assays were low.
Subject(s)
Adrenal Gland Diseases/diagnosis , Adrenal Gland Neoplasms/diagnosis , Adrenal Insufficiency/diagnosis , Antitubercular Agents/administration & dosage , Tuberculosis, Endocrine/diagnosis , Adrenal Gland Diseases/drug therapy , Adrenal Gland Diseases/microbiology , Adrenal Gland Neoplasms/microbiology , Adrenal Insufficiency/microbiology , Disease Progression , Humans , Interferon-gamma Release Tests , Male , Middle Aged , Treatment Outcome , Tuberculosis, Endocrine/drug therapyABSTRACT
A 70-year-old man with history of heart transplant performed in 1986, presented with altered mental status. CT scan of brain showed ring-enhancing lesions, raising suspicion for metastatic malignancy. Work-up revealed bilateral adrenal masses, biopsy showed granulomatous changes consistent with histoplasmosis. The possibility of histoplasmosis was less likely as the patient had no prior history of symptomatic disease and had lived in the endemic area 30 years prior to presentation. Brain biopsy confirmed central nervous system involvement. Amphotericin B was initiated for disseminated disease but his hospital course was complicated by renal failure and new liver hypodensities on follow-up imaging. Acute progressive disseminated histoplasmosis can manifest after decades of initial exposure and should always be in differential diagnosis even in non-endemic areas for prompt diagnosis and better clinical outcome.
Subject(s)
Adrenal Gland Diseases/microbiology , Brain/diagnostic imaging , Heart Transplantation/adverse effects , Histoplasmosis/diagnosis , Histoplasmosis/microbiology , Adrenal Gland Diseases/diagnostic imaging , Adrenal Gland Diseases/pathology , Aged , Amphotericin B/administration & dosage , Amphotericin B/therapeutic use , Antifungal Agents/therapeutic use , Brain/pathology , Delayed Diagnosis , Diagnosis, Differential , Histoplasma/isolation & purification , Histoplasmosis/diagnostic imaging , Histoplasmosis/pathology , Humans , Magnetic Resonance Imaging , Male , Tomography, X-Ray Computed , Transplant Recipients , Treatment OutcomeABSTRACT
A 70-year-old man with T-cell deficiency experienced continuous right waist pain and a low degree of fever. Abdominal CT found a large right adrenal mass. FDG PET/CT imaging was acquired to identify the nature of this likely malignant mass and search for potential metastases. The images revealed increased FDG activity in the mass. The patient received right adrenalectomy. Postsurgical pathological and microbial examination demonstrated adrenal cryptococcosis.
Subject(s)
Adrenal Gland Diseases/diagnostic imaging , Cryptococcosis/diagnostic imaging , Fluorodeoxyglucose F18 , Positron Emission Tomography Computed Tomography , Adrenal Gland Diseases/microbiology , Adrenal Gland Diseases/pathology , Aged , Cryptococcosis/pathology , Humans , MaleSubject(s)
Adrenal Gland Diseases/microbiology , Adrenal Insufficiency/etiology , Mycobacterium tuberculosis/isolation & purification , Thoracic Wall/microbiology , Tuberculosis/diagnosis , Adrenal Gland Diseases/diagnostic imaging , Aged , Antitubercular Agents/therapeutic use , Female , Humans , Magnetic Resonance Imaging , Thoracic Wall/diagnostic imaging , Tomography, X-Ray Computed , Tuberculosis/drug therapy , Tuberculosis/pathologyABSTRACT
OBJECTIVE: Histoplasmosis is an infectious disease caused by the dimorphic fungus Histoplasma capsulatum, endemic in central and eastern states of United States, South America and Africa. India is considered to be non-endemic area for histoplasmosis. Disseminated histoplasmosis may affect almost all systems. Disseminated histoplasmosis with asymptomatic adrenal involvement has been described in immunocompromised patients; whereas isolated adrenal involvement with adrenal insufficiency as the presenting manifestation of the disease is rare. MATERIAL AND METHOD: Twelve patients from a non-endemic area with adrenal histoplasmosis, who were immunocompetent and diagnosed as adrenal histoplasmosis by cytology/histopathology between January 2012 to December 2014 were studied. 18F-FDG PET/CT (fluorodeoxyglucose positron emission tomography/computed tomography) was used to assess the extent of involvement. RESULTS: There were a total of 12 immunocompetent males (mean age: 56.9 years). Ten patients had bilateral adrenal involvement and two had a unilateral left adrenal mass. All the patients had histopathologically/cytologically proven adrenal histoplasmosis. Two patients had simultaneous histoplasmosis of other sites, one in the epiglottis and the other in the alveolus. 18F-FDG PET/CT was performed in 10 patients showing high FDG uptake in the adrenals. All these patients received Amphotericin B and/or Itraconazole treatment that led to symptomatic improvement. CONCLUSION: A diagnosis of invasive fungal infection requires a high index of suspicion, especially in immunocompetent patients who present with nonspecific symptoms, clinical signs, laboratory and radiological features that can resemble adrenal neoplasms. Clinical specimens must be sent for cytopathology/histopathology together with fungal culture for a definite diagnosis and appropriate management.
Subject(s)
Adrenal Gland Diseases/diagnosis , Adrenal Gland Diseases/microbiology , Adrenal Insufficiency/diagnosis , Histoplasmosis/diagnosis , Adrenal Gland Diseases/pathology , Adrenal Insufficiency/pathology , Adult , Aged , Histoplasmosis/pathology , Humans , Male , Middle Aged , Positron Emission Tomography Computed Tomography , Retrospective StudiesABSTRACT
Non-invasive characterization of adrenal lesions is a commonly encountered diagnostic challenge. Characteristic clinical and correlative imaging findings may assist in only arriving at a probable diagnosis. Currently, (18)F-FDG PET/CT is considered to provide the most comprehensive imaging information. We here present a case of bilateral adrenal tuberculosis that highlights the need for caution during the interpretation of (18)F-FDG PET/CT and also the need to suggest histopathological correlation.
Subject(s)
Adrenal Gland Diseases/diagnostic imaging , Adrenal Gland Diseases/microbiology , Adrenal Gland Neoplasms/diagnostic imaging , Fluorodeoxyglucose F18 , Positron Emission Tomography Computed Tomography , Radiopharmaceuticals , Tuberculosis, Endocrine/diagnostic imaging , Diagnosis, Differential , Humans , Male , Middle AgedABSTRACT
Paracoccidioidomycosis and histoplasmosis are systemic fungal infections endemic in Brazil. Disseminated clinical forms are uncommon in immunocompetent individuals. We describe two HIV-negative patients with disseminated fungal infections, paracoccidioidomycosis and histoplasmosis, who were diagnosed by biopsies of suprarenal lesions. Both were treated for a prolonged period with oral antifungal agents, and both showed favorable outcomes.
A paracoccidioidomicose e a histoplasmose são infecções fúngicas sistêmicas endêmicas no Brasil. As formas clínicas disseminadas são incomuns em pacientes imunocompetentes. Nós descrevemos dois pacientes HIV-negativos com infecções fúngicas disseminadas, paracoccidioidomicose e histoplasmose, que foram diagnosticadas por biópsias de lesões de supra-renal. Ambos foram tratados por períodos prolongados com antifúngicos orais, evoluindo com boa resposta terapêutica.
Subject(s)
Humans , Male , Middle Aged , Adrenal Gland Diseases/diagnosis , Central Nervous System Fungal Infections/diagnosis , Facial Dermatoses/diagnosis , Histoplasmosis/diagnosis , Paracoccidioidomycosis/diagnosis , Adrenal Gland Diseases/microbiology , Biopsy , Brazil , Central Nervous System Fungal Infections/microbiology , Facial Dermatoses/microbiology , Immunocompetence/physiologyABSTRACT
We report a rare case of xanthogranulomatous adrenalitis in a 55-year-old man. The patient presented to the hospital with fever, nausea, and right flank pain. His medical history was significant for diabetes and an adrenal mass that was detected 6 years prior to presentation during a computed tomography (CT) scan for trauma secondary to a motor vehicle collision. The mass was thought to be a myelolipoma. Magnetic resonance imaging (MRI) revealed a 12-cm right adrenal mass that was considered suspicious for carcinoma, which was surgically excised and cultured intraoperatively. The cultures subsequently grew methicillin-resistant Staphylococcus aureus (MRSA). Grossly, the adrenal mass was an encapsulated, necrotic lesion with surrounding areas of fat necrosis. On histologic examination, the tissue showed sheets of histiocytes, lymphocytes, and plasma cells diffusely involving the adrenal gland along with bright yellow lipofuscin crystals in a background of necrosis and fibrosis.
Subject(s)
Adrenal Gland Diseases/complications , Diabetes Complications , Granuloma/complications , Inflammation/pathology , Staphylococcal Infections/complications , Xanthomatosis/complications , Adrenal Gland Diseases/microbiology , Adrenal Gland Diseases/pathology , Diabetes Complications/microbiology , Diabetes Complications/pathology , Granuloma/microbiology , Granuloma/pathology , Humans , Inflammation/complications , Inflammation/microbiology , Male , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Middle Aged , Staphylococcal Infections/pathology , Xanthomatosis/microbiology , Xanthomatosis/pathologyABSTRACT
A 64-year-old female with primary adrenal insufficiency presented with a right adrenal mass showing quantitative nonadenoma features on dedicated adrenal computed tomography (CT). CT showed direct invasion of the mass to the adjacent hepatic parenchyma, and high uptake was noted on 18F-fluorodeoxyglucose positron emission tomography/CT. Laparoscopy revealed gross invasion of the adrenal lesion into the liver, which led to the en bloc resection including the involved liver. Polymerase chain reaction analysis of the surgical specimen revealed adrenal tuberculosis.
Subject(s)
Adrenal Gland Diseases/diagnosis , Adrenal Glands/microbiology , Adrenalectomy/methods , Mycobacterium tuberculosis/isolation & purification , Positron-Emission Tomography/methods , Tomography, X-Ray Computed/methods , Tuberculosis, Endocrine/diagnosis , Adrenal Gland Diseases/microbiology , Adrenal Gland Diseases/surgery , Adrenal Gland Neoplasms/diagnosis , Adrenal Glands/surgery , DNA, Bacterial/analysis , Diagnosis, Differential , Female , Humans , Laparoscopy/methods , Liver Neoplasms/diagnosis , Middle Aged , Mycobacterium tuberculosis/genetics , Tuberculosis, Endocrine/microbiology , Tuberculosis, Endocrine/surgeryABSTRACT
Invasive aspergillosis, an infection most frequently induced by Aspergillus fumigatus and Aspergillus flavus, typically occurs in immunocompromised patients and is usually transmitted through inhalation of Aspergillus spores. As the lungs are by far the most common site involved in invasive aspergillosis and invasive aspergillosis in immunocompetent hosts is very rare, there have been a few case reports of extra-pulmonary, disseminated invasive aspergillosis in immunocompetent persons. Herein, we report a case of an adult, male, immunocompetent patient with disseminated invasive aspergillosis that successively spread from the right adrenal gland to the left hepatic lobe. The patient was successfully treated through surgical excisions of his adrenal and hepatic masses followed by voriconazole therapy. To our knowledge, this is the first case report of invasive aspergillosis affecting the adrenal glands.
Subject(s)
Adrenal Gland Diseases/diagnosis , Aspergillosis/diagnosis , Liver Diseases/diagnosis , Adrenal Gland Diseases/drug therapy , Adrenal Gland Diseases/microbiology , Adrenal Gland Diseases/surgery , Adrenal Glands/diagnostic imaging , Adrenal Glands/microbiology , Adrenal Glands/surgery , Adult , Antifungal Agents/therapeutic use , Aspergillosis/drug therapy , Aspergillosis/microbiology , Aspergillosis/surgery , Aspergillus/isolation & purification , Combined Modality Therapy , Humans , Immunocompetence , Liver/diagnostic imaging , Liver/microbiology , Liver/surgery , Liver Diseases/drug therapy , Liver Diseases/microbiology , Liver Diseases/surgery , Male , Radiography , Voriconazole/therapeutic useABSTRACT
Paracoccidioidomycosis and histoplasmosis are systemic fungal infections endemic in Brazil. Disseminated clinical forms are uncommon in immunocompetent individuals. We describe two HIV-negative patients with disseminated fungal infections, paracoccidioidomycosis and histoplasmosis, who were diagnosed by biopsies of suprarenal lesions. Both were treated for a prolonged period with oral antifungal agents, and both showed favorable outcomes.
Subject(s)
Adrenal Gland Diseases/diagnosis , Central Nervous System Fungal Infections/diagnosis , Facial Dermatoses/diagnosis , Histoplasmosis/diagnosis , Paracoccidioidomycosis/diagnosis , Adrenal Gland Diseases/microbiology , Biopsy , Brazil , Central Nervous System Fungal Infections/microbiology , Facial Dermatoses/microbiology , Humans , Immunocompetence/physiology , Male , Middle AgedSubject(s)
Adrenal Gland Diseases/diagnosis , Granuloma/diagnosis , Testicular Diseases/diagnosis , Tuberculoma/diagnosis , Adrenal Gland Diseases/drug therapy , Adrenal Gland Diseases/microbiology , Antitubercular Agents/therapeutic use , Diagnosis, Differential , Granuloma/microbiology , Granuloma/surgery , Humans , Male , Middle Aged , Testicular Diseases/microbiology , Testicular Diseases/surgery , Tuberculoma/complications , Tuberculoma/therapy , Tuberculoma, Intracranial/complications , Tuberculoma, Intracranial/diagnosis , Tuberculoma, Intracranial/drug therapyABSTRACT
A retrospective series of five cases of nontraumatic gross adrenal hemorrhage were identified in 800 consecutive forensic autopsies. All patients were males, of different ethnicities and with ages ranging from 2 to 48 years. All patients had a clinical history and autopsy findings suggestive of sepsis. Pre- or postmortem microbiological cultures were variably positive for Pseudomonas aeruginosa, Streptococcus pneumoniae, Staphylococcus aureus, and methicillin-resistant Staphylococcus aureus. The fifth case was positive for yeast and a coagulase negative staphylococcus; contamination of this culture medium cannot be excluded. No cases had a culture positive for Neisseria meningitidis. We find that the reviewed patients with grossly or microscopically identifiable adrenal hemorrhage were otherwise healthy individuals who died suddenly as a consequence of bacterial infection. In each case, signs and symptoms compatible with premortem adrenal insufficiency were reported; in no instance was the adrenal hemorrhage clinically identified.