一例肾上腺巨大结核并肾上腺皮质功能减退 病例报告及文献复习

A Case Report and Literature Review of Giant Adrenal Tuberculosis Complicated by Adrenal Cortical Hypofunction

摘要: 肾上腺结核是导致原发性肾上腺皮质功能减退症(Addison病)的重要感染性病因，但因其临床症状隐匿，巨大病灶的影像学表现易与肿瘤混淆，常导致误诊。本文报道一例以“纳差、消瘦”等非特异性症状起病，影像学高度怀疑为“肾上腺皮质癌伴肾静脉癌栓形成”的病例。通过深入分析其诊疗过程，揭示该患者最终经内分泌功能评估及穿刺活检确诊为双侧肾上腺结核并原发性肾上腺皮质功能减退。本文结合文献，探讨了本病的临床特点、诊断思路及治疗原则，以提升临床认识，减少误诊。

Abstract: Adrenal tuberculosis is a significant infectious cause of primary adrenocortical insufficiency (Addison’s disease). However, due to its subtle clinical symptoms and imaging features of large lesions that can easily be confused with tumors, misdiagnosis is common. This article reports a case that initially presented with non‑specific symptoms such as poor appetite and weight loss, and was highly suspected on imaging to be “adrenal cortical carcinoma with renal vein tumor thrombus.” Through an in‑depth analysis of the diagnostic and treatment process, it is revealed that the patient was ultimately diagnosed with bilateral adrenal tuberculosis and primary adrenocortical insufficiency based on endocrine function evaluation and needle biopsy. Combined with a review of the literature, this article discusses the clinical features, diagnostic approach, and treatment principles of this disease, aiming to enhance clinical awareness and reduce misdiagnosis.