Objective:To document the clinical,biochemical and imaging phenotypes of immunocompetent patients with adrenal histoplasmosis.Methods:The clinical,biochemical and radiologic data of 18 immunocompetent patients[age:45....Objective:To document the clinical,biochemical and imaging phenotypes of immunocompetent patients with adrenal histoplasmosis.Methods:The clinical,biochemical and radiologic data of 18 immunocompetent patients[age:45.00(39.25,56.25)years,median(IQR),m/f(16/2)]with adrenal histoplasmosis presenting in the Department of Endocrinology,BSMMU between 2014 and 2020 were retrospectively analyzed.Results:All patients were seronegative for HIV infection,and 27.8%(5/18)had well controlled diabetes mellitus.The median duration of the symptoms was 6.00(IQR:4.00,11.25)months.All had significant weight loss,anorexia and weakness.Fever was present in 61.1%(11/18)patients and night sweat was present in 27.8%(5/18)cases.Hypotension and hyperpigmentation were present in 55.6%(10/18)and 66.7%(12/18)cases,respectively.Three of 18 patients presented with adrenal crisis.Hyponatremia occurred in 55.6%(10/18)cases,but none had hyperkalemia.Thirteen of 18 patients had adrenal insufficiency whereas 83.3%(15/18)had high adrenocorticotropic hormone.CT scan revealed bilateral adrenal enlargement in all cases with oval shape and regular margin.All were hypodense having radiodensity 21-90 hounsfield unit,and 11.1%(2/18)were heterogeneous in contrast enhancement.None had noticeable calcification whereas 1.1%(2/18)cases had central necrosis with peripheral rim enhancement.Hepatomegaly was present in 6 cases,splenomegaly in 3 cases and 5 patients had abdominal lymphadenopathy.Histoplasmosis were confirmed by positive fine needle aspiration cytology of adrenal tissue.Conclusions:Adrenal histoplasmosis should be considered in the list of differentials of bilateral adrenomegaly in immunocompetent individuals even living in non-endemic areas.展开更多
文摘Objective:To document the clinical,biochemical and imaging phenotypes of immunocompetent patients with adrenal histoplasmosis.Methods:The clinical,biochemical and radiologic data of 18 immunocompetent patients[age:45.00(39.25,56.25)years,median(IQR),m/f(16/2)]with adrenal histoplasmosis presenting in the Department of Endocrinology,BSMMU between 2014 and 2020 were retrospectively analyzed.Results:All patients were seronegative for HIV infection,and 27.8%(5/18)had well controlled diabetes mellitus.The median duration of the symptoms was 6.00(IQR:4.00,11.25)months.All had significant weight loss,anorexia and weakness.Fever was present in 61.1%(11/18)patients and night sweat was present in 27.8%(5/18)cases.Hypotension and hyperpigmentation were present in 55.6%(10/18)and 66.7%(12/18)cases,respectively.Three of 18 patients presented with adrenal crisis.Hyponatremia occurred in 55.6%(10/18)cases,but none had hyperkalemia.Thirteen of 18 patients had adrenal insufficiency whereas 83.3%(15/18)had high adrenocorticotropic hormone.CT scan revealed bilateral adrenal enlargement in all cases with oval shape and regular margin.All were hypodense having radiodensity 21-90 hounsfield unit,and 11.1%(2/18)were heterogeneous in contrast enhancement.None had noticeable calcification whereas 1.1%(2/18)cases had central necrosis with peripheral rim enhancement.Hepatomegaly was present in 6 cases,splenomegaly in 3 cases and 5 patients had abdominal lymphadenopathy.Histoplasmosis were confirmed by positive fine needle aspiration cytology of adrenal tissue.Conclusions:Adrenal histoplasmosis should be considered in the list of differentials of bilateral adrenomegaly in immunocompetent individuals even living in non-endemic areas.
