Thread by @drnitinyashas

Diagnose this!
50 year old male. cervical lymph nodes. inguinal lymph nodes. FNAC s/o TB . Started on ATT. After few days
Presents to ER with BP of 84/60, Sodium 122, GRBS 50
1 imaging test to evaluate?
1 drug which may have caused this?
Diagnosis?
#MedTwitter #MedStudents

Yes indeed
Adrenal #tuberculosis is one of the most common causes of #addisons disease
Rifampicin can precipitate a crisis as it increases the metabolism of cortisol and lowers its levels
Infact Rifampicin can unmask pre existing adrenal insufficiency.
#MedTwitter #MBBS

#Tuberculosis of adrenal glands occurs when ususally >90% of the gland is destroyed by TB.
usually bilateral in more than 70%.
Hence treatment of coexistent TB may not reverse the insufficiency.
#MedTwitter #MBBS

Usually 5 days are required for hepatic induction of enzymes once rifampicin is started for Addison symptoms.
Hence early morning cortisol test before starting rifampicin esp if imaging evidence of adrenal TB.
CT: bilateral adrenal enlargement, calcification
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Hence patient on rifampicin developing these symptoms, think of Adrenal TB with Addisons disease .
Can occassionaly be cause of sudden death in TB infection.
#tuberculosis #MedTwitter #MBBS

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Addisons, TB, Rifampicin- the deadly trio.

@Endoananth @thehormoneD0C - ur views and how many u have encountered? I encountered quite a few as my thesis was on extrapulmonary TB.