Bilateral Adrenal Masses Mimicking Neoplasm: A Case of Adrenal Tuberculosis

Abstract

Bilateral adrenal masses often raise alarm for neoplasm, but in countries where tuberculosis (TB) is common, infection must remain an important consideration. We describe the case of a 50-year-old man with adrenal insufficiency who presented with weight loss and fatigue. Ultrasound revealed bilateral adrenal enlargement with hepatosplenomegaly. A contrast-enhanced computed tomography adrenal protocol showed bulky, lobulated adrenal masses with rim enhancement and poor washout (<60%), making adenoma unlikely. The surrounding fat planes were intact, and no vascular invasion was seen. Ultrasonography-guided biopsy demonstrated ill-formed epithelioid granulomas with caseation necrosis, confirming adrenal TB. Adrenal TB is a great mimicker, often resembling carcinoma, lymphoma, or metastasis. In endemic regions, it should always be part of the differential diagnosis when adrenal insufficiency and bilateral adrenal masses coexist. Correlation of imaging with histopathology is vital, not only to prevent misdiagnosis but also to allow early anti-tubercular treatment and avoid unnecessary surgery.