Primary adrenal insufficiency in india
TB
· Addison’s disease results from progressive destruction of the
adrenals, which must involve 90% of the glands before
adrenal insufficiency appears.
· The adrenal is a frequent site for chronic granulomatous
diseases, predominantly tuberculosis but also histoplasmosis,
coccidioidomycosis, and cryptococcosis.
· In early series, tuberculosis was responsible for 70 to 90%
of cases, but the most frequent cause now is idiopathic
atrophy, and an autoimmune mechanism is probably
responsible.
· Specific adrenal antigens to which autoantibodies may be
directed include 21-hydroxylase (CYP21A2) and side chain
cleavage enzyme.