Addison’s disease due to adrenal insufficiency in an immunocompetent patient with disseminated cryptococcosis. Case report

José Paz-Ibarra; Marcio Concepción-Zavaleta; Miguel Tipiani Mallma; Héctor Delgado-Nicolás; Hilder Herrera-Silvestre; Laurie Marcilla-Truyenque; Joseph Arzapalo-Benavides; Luis Concepción-Urteaga

doi:10.17843/rpmesp.2025.422.14304

Authors

José Paz-Ibarra Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Lima, Perú. Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú. https://orcid.org/0000-0002-2851-3727
Marcio Concepción-Zavaleta Universidad Científica del Sur, Lima, Perú https://orcid.org/0000-0001-9719-1875
Miguel Tipiani Mallma Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú https://orcid.org/0000-0002-0892-4035
Héctor Delgado-Nicolás Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú https://orcid.org/0009-0003-7055-7496
Hilder Herrera-Silvestre Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú https://orcid.org/0009-0003-4772-8795
Laurie Marcilla-Truyenque Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú https://orcid.org/0000-0003-1250-6407
Joseph Arzapalo-Benavides Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú https://orcid.org/0009-0003-6982-5668
Luis Concepción-Urteaga Facultad de Medicina, Universidad Nacional de Trujillo, Trujillo, Perú https://orcid.org/0000-0003-0462-3101

DOI:

https://doi.org/10.17843/rpmesp.2025.422.14304

Keywords:

Adrenal insufficiency, Addison disease, Cryptococcus

Abstract

Systemic mycoses, such as cryptococcosis, mainly affect the lungs and central nervous system; however, involvement of other organs, such as the adrenal glands, is rare. This has been described in some cases of
primary adrenal insufficiency (PAI) of fungal origin, which are associated with high mortality. We present the case of a 65-year-old immunocompetent man who presented clinical manifestations of adrenal insufficiency. Biochemical tests confirmed PAI, and abdominal tomography revealed hyperplasia of both adrenal glands, predominantly on the left side. Left adrenalectomy was performed, and pathological examination identified

Downloads

Download data is not yet available.

References

Hahner S, Ross RJ, Arlt W, Bancos I, Burger-Stritt S, Torpy DJ, et al. Adrenal insufficiency. Nat Rev Dis Primers. 2021;7(1):19. doi: 10.1038/s41572-021-00252-7.

Lindh JD, Patrova J, Rushworth RL, Mannheimer B, Falhammar H. Tuberculosis of Adrenal Glands-A Population-based Case-control Study. J Endocr Soc. 2023;7(5):bvad047. doi: 10.1210/jendso/bvad047.

Lee YC, Wang JT, Sun HY, Chen YC. Comparisons of clinical features and mortality of cryptococcal meningitis between patients with and without human immunodeficiency virus infection. J Microbiol Immunol Infect. 2011;44(5):338-345. doi: 10.1016/j.jmii.2010.08.011.

Chang CC, Harrison TS, Bicanic TA, Chayakulkeeree M, Sorrell TC, Warris A, et al. Global guideline for the diagnosis and management of cryptococcosis: an initiative of the ECMM and ISHAM in cooperation with the ASM. Lancet Infect Dis. 2024;24(8):e495-e512. doi: 10.1016/S1473-3099(24)00426-2.

Hsu E, Webster SM, Nanes M. Disseminated Cryptococcosis in An Immunocompetent Host Presenting As Osteomyelitis and Leading to Adrenal Insufficiency. Am J Med Sci. 2022;363(1):75-79. doi:10.1016/J.amjms.2020.12.007.

Hung ZS, Lai YH, Hsu YH, Wang CH, Fang TC, Hsu BG. Disseminated cryptococcosis causes adrenal insufficiency in an immunocompetent individual. Intern Med. 2010;49(11):1023-1026. doi: 10.2169/internalmedicine.49.3051.

Cheng HM, Chou ASB, Chiang KH, Huang HW, Chang PY, Yen PS. Primary adrenal insufficiency in isolated cryptococcosis of the adrenal gland: CT and MR imaging appearances. Eur J Radiol Extra. 2010;74(1):16-20. doi: 10.1016/j.ejrex.2010.05.006.

Chang CC, Harrison TS, Bicanic TA, Chayakulkeeree M, Sorrell TC, Warris A, et al. Global guideline for the diagnosis and management of cryptococcosis: an initiative of the ECMM and ISHAM in cooperation with the ASM. Lancet Infect Dis. 2024;24(8):e495-e512. doi: 10.1016/S1473-3099(23)00731-4.

Cortés JA, Valderrama-Rios MC, Lizarazo J, Millán-Oñate J, Diaz-Brochero C, Gómez Quintero CH, et al. Guía de práctica clínica para el diagnóstico y tratamiento de la criptococosis en personas adultas que viven con el VIH. Infectio. 2024;28(1):45-67.

Quincho-Lopez A, Kojima N, Nesemann JM, Verona-Rubio R, Carayhua-Perez D. Cryptococcal infection of the colon in a patient without concurrent human immunodeficiency infection: a case report and literature review. Eur J Clin Microbiol Infect Dis. 2021;40(12):2623-2626. doi: 10.1007/s10096-021-04268-5.

Qureshi ZA, Ghazanfar H, Altaf F, Ghazanfar A, Hasan KZ , Kandhi S, et al. Cryptococcosis and Cryptococcal Meningitis: A Narrative Review and the Up-to-Date Management Approach. Cureus. 2024;16(3):e55498. doi: 10.7759/cureus.55498.

Betterle C, Presotto F, Furmaniak J. Epidemiology, pathogenesis, and diagnosis of Addison’s disease in adults. J Endocrinol Invest. 2019;42(12):1407-1433. doi: 10.1007/s40618-019-01079-6.

Hahner S, Ross RJ, Arlt W, Bancos I, Burger-Stritt S, Torpy DJ, et al. Adrenal insufficiency. Nat Rev Dis Primers. 2021 Mar 11;7(1):19. doi: 10.1038/s41572-021-00252-7.

Wang Y, Gu Y, Shen K, Cui X, Min R, Sun S, et al. The management and outcome of cryptococcosis in patients with different immune statuses and treatment protocols: A multicenter real-world study in Jiangsu Province–China. J Med Mycol. 2023;33(3):101389. doi: 10.1016/j.mycmed.2023.101389.

Lomes NR, Melhem MS, Szeszs MW, Martins MA, Buccheri R. Cryptococcosis in non-HIV/non-transplant patients: a Brazilian case series. Med Mycol. 2016;54(7):669–676. doi: 10.1093/mmy/myw021.

Zavala S, Baddley JW. Cryptococcosis. Semin Respir Crit Care Med. 2020;41(1):69-79. doi: 10.1055/s-0039-3400280.

Gligorijevic N, Kaljevic M, Radovanovic N, Jovanovic F, Joksimovic V, Singh S, et al. Adrenal Abscesses: A Systematic Review of the Literature. J Clin Med. 2023;12(14):4601. doi:10.3390/jcm12144601.

Paolo WF Jr, Nosanchuk JD. Adrenal infections. Int J Infect Dis. 2006;10(5):343–353. doi: 10.1016/j.ijid.2005.08.001.

Beishuizen A, Thijs LG. Endotoxin and the hypothalamo-pituitary-adrenal (HPA) axis. J Endotoxin Res. 2003;9(1):3-24. doi:

1179/096805103125001298.

Rathore SS, Sathiyamoorthy J, Lalitha C, Ramakrishnan J. A holistic review on Cryptococcus neoformans. Microb Pathog. 2022;166:105521. doi: 10.1016/j.micpath.2022.105521.

Price CE, Burns C, Aloi JA. Primary Adrenal Insufficiency due to Cryptococcus With Persistent Adrenal Enlargement and Insufficiency. AACE Clin Case Rep. 2023;9(6):189-192. doi: 10.1016/j.aace.2023.09.002.

Thompson A. FRI235 Primary Adrenal Insufficiency As Presenting Symptom Of Disseminated Histoplasmosis And Cryptococcus Co-Infection In Immunocompetent Patient. J Endocr Soc. 2023;7(Suppl 1):bvad114.230. doi: 10.1210/jendso/bvad114.230.

Ito M, Hinata T, Tamura K, Koga A, Ito T, Fujii H, et al. Disseminated Cryptococcosis with Adrenal Insufficiency and Meningitis in an Immunocompetent Individual. Intern Med. 2017;56(10):1259-1264. doi: 10.2169/internalmedicine.56.7356.

Perfect JR, Dismukes WE, Dromer F, Goldman DL, Graybill JR, Hamill RJ, et al. Clinical practice guidelines for the management of cryptococcal disease: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis. 2010;50(3):291-322. doi:10.1086/649858.

Gushiken AC, Saharia KK, Baddley JW. Cryptococcosis. Infect Dis Clin North Am. 2021;35(2):493-514. doi: 10.1016/j.idc.2021.03.012.