2026, Vol. 7
Issue (5): 665-672 DOI: 10.19983/j.issn.2096-8493.20260062
• Review Articles • Previous Articles Next Articles
Received:2026-03-30
Online:2026-10-20
Published:2026-10-19
Contact:
Li Yingying
E-mail:877837794@qq.com
CLC Number:
Li Yingying, Ren Yan. Research progress on adrenal insufficiency associated with adrenal tuberculosis[J]. Journal of Tuberculosis and Lung Disease, 2026, 7(5): 665-672. doi: 10.19983/j.issn.2096-8493.20260062
Add to citation manager EndNote|Ris|BibTeX
URL: https://www.jtbld.cn/EN/10.19983/j.issn.2096-8493.20260062
| 项目 | 肾上腺结核 | 自身免疫性Addison病 | 肾上腺转移瘤 | 真菌感染 |
|---|---|---|---|---|
| 病因 | 结核分枝杆菌感染 | 自身免疫介导 | 恶性肿瘤转移 | 真菌感染(组织胞浆菌、隐球菌等) |
| 受累特点 | 多为双侧 | 双侧为主 | 单侧或双侧 | 多为双侧 |
| 全身表现 | 发热、盗汗、消瘦 | 多无感染症状 | 原发肿瘤相关症状 | 发热、免疫抑制背景 |
| 影像学表现 | 早期增大,中期坏死,晚期萎缩+钙化(特征性) | 正常或萎缩,少见钙化 | 占位性病变,边界清晰,强化不均 | 增大+坏死,类似结核病,少见钙化 |
| 实验室检查特点 | γ-干扰素释放试验阳性,PCR可检出结核分枝杆菌DNA | 21-羟化酶抗体阳性 | 肿瘤标志物异常 | 真菌抗原/培养阳性 |
| 内分泌特点 | 原发性肾上腺功能减退 | 原发性肾上腺功能减退 | 多无功能或晚期受损 | 可出现功能减退 |
| 临床提示点 | 双侧病变+钙化+结核病病史 | 合并其他自身免疫病 | 明确肿瘤病史 | 免疫抑制状态 |
| [1] |
Valdes-Socin H, Vroonen L, Pétrossians P. Addison’s disease: looking to the past and the future[J]. Rev Med Liege, 2025, 80(1): 48-54.
pmid: 39815705 |
| [2] |
Gupta S, Ansari M A M, Gupta A K, et al. Current Approach for Diagnosis and Treatment of Adrenal Tuberculosis-Our Experience and Review of Literature[J]. Surg J (N Y), 2022, 8(1): e92-e97. doi:10.1055/s-0042-1743523.
pmid: 35252566 |
| [3] | Rowińska-Zakrzewska E, Szopiński J, Remiszewski P, et al. Tuberculosis in the autopsy material: analysis of 1500 autopsies performed between 1972 and 1991 in the Institute of Tuberculosis and Chest Diseases, Warsaw, Poland[J]. Tuber Lung Dis, 1995, 76(4): 349-354. doi:10.1016/s0962-8479(05)80035-8. |
| [4] |
Vaidya A, Findling J, Bancos I. Adrenal Insufficiency in Adults: A Review[J]. JAMA, 2025, 334(8): 714-725. doi:10.1001/jama.2025.5485.
pmid: 40522647 |
| [5] | World Health Organization. Global tuberculosis report 2025[R]. Geneva: World Health Organization, 2025. |
| [6] | Klingmüller A, Steinke J, Rybniker J, et al. Extrapulmonary tuberculosis[J]. Dtsch Med Wochenschr, 2025, 150(20): 1189-1196. doi:10.1055/a-2597-9679. |
| [7] |
Muneer A, Macrae B, Krishnamoorthy S, et al. Urogenital tuberculosis-epidemiology, pathogenesis and clinical features[J]. Nat Rev Urol, 2019, 16(10): 573-598. doi:10.1038/s41585-019-0228-9.
pmid: 31548730 |
| [8] |
Fofi C, Maresca B, Altieri S, et al. Renal involvement in adrenal insufficiency (Addison disease): can we always recognize it?[J]. Intern Emerg Med, 2020, 15(1): 23-31. doi:10.1007/s11739-019-02209-x.
pmid: 31625077 |
| [9] | Kibirige D, Owarwo N, Kyazze A P, et al. Prevalence, Clinical Features, and Predictors of Adrenal Insufficiency in Adults With Tuberculosis or HIV: A Systematic Review and Meta-analysis[J]. Open Forum Infect Dis, 2024, 11(4): ofae098. doi:10.1093/ofid/ofae098. |
| [10] | Mifsud S, Gauci Z, Gruppetta M, et al. Adrenal insufficiency in HIV/AIDS: a review[J]. Expert Rev Endocrinol Metab, 2021, 16(6):351-362. doi:10.1080/17446651.2021.1979393. |
| [11] | 刘儒卓, 苏容, 李东民. HIV与结核分枝杆菌合并感染现状及影响因素的研究进展[J]. 中华流行病学杂志, 2025, 46(1): 166-174. doi:10.3760/cma.j.cn112338-20240806-00478. |
| [12] | Zeding Z, Liu L, Wang C, et al. A retrospective analysis of 25 cases of Addison’s disease caused by adrenal tuberculosis in Tibet and review of related literature[J]. J Clin Tuberc Other Mycobact Dis, 2023, 31: 100358. doi:10.1016/j.jctube.2023.100358. |
| [13] | 马慧敏, 张丽帆, 刘晓清. 潜伏性结核感染进展为活动性结核病的机制研究[J]. 结核与肺部疾病杂志, 2020, 1(3): 276-280. doi:10.3969/j.issn.2096-8493.2020.03.014. |
| [14] | Lindh J D, Patrova J, Rushworth R L, et al. Tuberculosis of Adrenal Glands-A Population-based Case-control Study[J]. J Endocr Soc, 2023, 7(5):bvad047. doi:10.1210/jendso/bvad047. |
| [15] | Zhang T X, Xu H Y, Ma W, et al. Addison’s disease caused by adrenal tuberculosis may lead to misdiagnosis of major depressive disorder: A case report[J]. World J Clin Cases, 2024, 12(1): 217-223. doi:10.12998/wjcc.v12.i1.217. |
| [16] | Ye D, Gan N, Yang Y, et al. Clinical characteristics of nine cases of adrenal tuberculosis and literature review[J]. Int Urol Nephrol, 2026, 58(6):2207-2232. doi:10.1007/s11255-025-04897-1. |
| [17] | 张梦迪, 王鑫, 郑文静, 等. 老年结核病危险因素研究进展[J]. 中国防痨杂志, 2024, 46(10): 1266-1272. doi:10.19982/j.issn.1000-6621.20240255. |
| [18] | 张铭锦, 刘绘影, 高嘉, 等. 结核潜伏感染的诊断现状与展望[J]. 中华传染病杂志, 2024, 42(8): 500-505. doi:10.3760/cma.j.cn311365-20240425-00117. |
| [19] |
Pai M, Behr M A, Dowdy D, et al. Tuberculosis[J]. Nat Rev Dis Primers, 2016, 2: 16076. doi:10.1038/nrdp.2016.76.
pmid: 27784885 |
| [20] |
Cain D W, Cidlowski J A. Immune regulation by glucocorticoids[J]. Nat Rev Immunol, 2017, 17(4): 233-247. doi:10.1038/nri.2017.1.
pmid: 28192415 |
| [21] | Warner D F, Barczak A K, Gutierrez M G, et al. Mycobacterium tuberculosis biology, pathogenicity and interaction with the host[J]. Nat Rev Microbiol, 2025, 23(12): 788-804. doi:10.1038/s41579-025-01201-x. |
| [22] | 金琳羚, 何梦钰, 周宏, 等. 巨噬细胞葡萄糖代谢重编程在结核肉芽肿形成中的作用[J]. 中华结核和呼吸杂志, 2023, 46(8): 834-838. doi:10.3760/cma.j.cn112147-20221119-00912. |
| [23] | Lyu J, Narum D E, Baldwin S L, et al. Understanding the development of tuberculous granulomas: insights into host protection and pathogenesis, a review in humans and animals[J]. Front Immunol, 2024, 15:1427559. doi:10.3389/fimmu.2024.1427559. |
| [24] | Basaraba R J, Hunter R L. Pathology of Tuberculosis: How the Pathology of Human Tuberculosis Informs and Directs Animal Models[J]. Microbiol Spectr, 2017, 5(3):10.1128/microbiolspec.tbtb2-0029-2016. doi:10.1128/microbiolspec.TBTB2-0029-2016. |
| [25] | Chandra P, Grigsby S J, Philips J A. Immune evasion and provocation by Mycobacterium tuberculosis[J]. Nat Rev Microbiol, 2022, 20(12): 750-766. doi:10.1038/s41579-022-00763-4. |
| [26] |
Zeng G, Zhang G, Chen X. Th1 cytokines, true functional signatures for protective immunity against TB?[J]. Cell Mol Immunol, 2018, 15(3): 206-215. doi:10.1038/cmi.2017.113.
pmid: 29151578 |
| [27] | Nguyen J A, Yates R M. Better Together: Current Insights Into Phagosome-Lysosome Fusion[J]. Front Immunol, 2021, 12: 636078. doi:10.3389/fimmu.2021.636078. |
| [28] | Amaral E P, Riteau N, Moayeri M, et al. Lysosomal Cathepsin Release Is Required for NLRP3-Inflammasome Activation by Mycobacterium tuberculosis in Infected Macrophages[J]. Front Immunol, 2018, 9: 1427. doi:10.3389/fimmu.2018.01427. |
| [29] |
Beckwith K S, Beckwith M S, Ullmann S, et al. Plasma membrane damage causes NLRP3 activation and pyroptosis during Mycobacterium tuberculosis infection[J]. Nat Commun, 2020, 11(1): 2270. doi:10.1038/s41467-020-16143-6.
pmid: 32385301 |
| [30] | D’Attilio L, Santucci N, Bongiovanni B, et al. Tuberculosis, the Disrupted Immune-Endocrine Response and the Potential Thymic Repercussion As a Contributing Factor to Disease Physiopathology[J]. Front Endocrinol (Lausanne), 2018, 9: 214. doi:10.3389/fendo.2018.00214. |
| [31] | Vecchione M B, Angerami M T, Suarez G V, et al. Immune variations throughout the course of tuberculosis treatment and its relationship with adrenal hormone changes in HIV-1 patients co-infected with Mycobacterium tuberculosis[J]. Tuberculosis (Edinb), 2021, 127: 102045. doi:10.1016/j.tube.2020.102045. |
| [32] |
Dorhoi A, Kaufmann S H. Pathology and immune reactivity: understanding multidimensionality in pulmonary tuberculosis[J]. Semin Immunopathol, 2016, 38(2): 153-166. doi:10.1007/s00281-015-0531-3.
pmid: 26438324 |
| [33] |
Pagán A J, Ramakrishnan L. The Formation and Function of Granulomas[J]. Annu Rev Immunol, 2018, 36: 639-665. doi:10.1146/annurev-immunol-032712-100022.
pmid: 29400999 |
| [34] |
Ehlers S, Schaible U E. The granuloma in tuberculosis: dynamics of a host-pathogen collusion[J]. Front Immunol, 2012, 3: 411. doi:10.3389/fimmu.2012.00411.
pmid: 23308075 |
| [35] |
Nathan C, Cunningham-Bussel A. Beyond oxidative stress: an immunologist’s guide to reactive oxygen species[J]. Nat Rev Immunol, 2013, 13(5): 349-361. doi:10.1038/nri3423.
pmid: 23618831 |
| [36] |
Wayne L G, Sohaskey C D. Nonreplicating persistence of Mycobacterium tuberculosis[J]. Annu Rev Microbiol, 2001, 55: 139-163. doi:10.1146/annurev.micro.55.1.139.
pmid: 11544352 |
| [37] |
Wynn T A. Cellular and molecular mechanisms of fibrosis[J]. J Pathol, 2008, 214(2): 199-210. doi:10.1002/path.2277.
pmid: 18161745 |
| [38] | Łukowski W. Reframing type 1 diabetes through the endocannabinoidome-microbiota axis: a systems biology perspective[J]. Front Endocrinol (Lausanne), 2025, 16: 1576419. doi:10.3389/fendo.2025.1576419. |
| [39] |
Bornstein S R, Allolio B, Arlt W, et al. Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline[J]. J Clin Endocrinol Metab, 2016, 101(2): 364-389. doi:10.1210/jc.2015-1710.
pmid: 26760044 |
| [40] | 任毅, 张瑾, 向晨昱, 等. 原发性慢性肾上腺皮质功能减退症15例临床特点分析和诊治体会[J]. 黑龙江医药, 2018, 31(4): 746-749. doi:10.14035/j.cnki.hljyy.2018.04.013. |
| [41] | Niemi M, Backman J T, Fromm M F, et al. Pharmacokinetic interactions with rifampicin: clinical relevance[J]. Clin Pharmacokinet, 2003, 42(9): 819-850. doi:10.2165/00003088-200342090-00003. |
| [42] | Kyriazopoulou V, Parparousi O, Vagenakis A G. Rifampicin-induced adrenal crisis in addisonian patients receiving corticosteroid replacement therapy[J]. J Clin Endocrinol Metab, 1984, 59(6): 1204-1206. doi:10.1210/jcem-59-6-1204. |
| [43] |
Snider D E Jr. Pyridoxine supplementation during isoniazid therapy[J]. Tubercle, 1980, 61(4): 191-196. doi:10.1016/0041-3879(80)90038-0.
pmid: 6269259 |
| [44] |
Wallace K B, Starkov A A. Mitochondrial targets of drug toxicity[J]. Annu Rev Pharmacol Toxicol, 2000, 40: 353-388. doi:10.1146/annurev.pharmtox.40.1.353.
pmid: 10836141 |
| [45] |
O’Neill L A, Kishton R J, Rathmell J. A guide to immunometabolism for immunologists[J]. Nat Rev Immunol, 2016, 16(9): 553-565. doi:10.1038/nri.2016.70.
pmid: 27396447 |
| [46] | Hotamisligil G S. Inflammation and metabolic disorders[J]. Nature, 2006, 444(7121): 860-867. doi:10.1038/nature05485. |
| [47] | Shang W, Bruno T F. Paradoxical Immune Reconstitution Inflammatory Syndrome Presenting as Extrapulmonary Tuberculosis in a Patient With HIV[J]. Cureus, 2026, 18(1): e100745. doi:10.7759/cureus.100745. |
| [48] | Vecchione M B, Giannone D A, Acevedo M V, et al. Adrenal and Metabolic Hormonal Axes Shape Anti-Tuberculosis Immune Responses in Human Immunodeficiency Virus-Tuberculosis Coinfection[J]. Neuroimmunomodulation, 2026, 33(1): 34-44. doi:10.1159/000550045. |
| [49] |
Asokan S. Immune issues in elderly with TB[J]. Indian J Tuberc, 2022, 69 Suppl 2: S241-S245. doi:10.1016/j.ijtb.2022.10.012.
pmid: 36400517 |
| [50] | van Arkel C, Storms I, Kurver L, et al. Elderly patients with tuberculosis in a low-incidence country-Clinical characteristics, inflammation and outcome[J]. J Infect, 2024, 89(2): 106200. doi:10.1016/j.jinf.2024.106200. |
| [51] | Galati A, Brown E S, Bove R, et al. Glucocorticoids for therapeutic immunosuppression: Clinical pearls for the practicing neurologist[J]. J Neurol Sci, 2021, 430:120004. doi:10.1016/j.jns.2021.120004. |
| [52] | Aravindhan V, Yuvaraj S. Immune-endocrine network in diabetes-tuberculosis nexus: does latent tuberculosis infection confer protection against meta-inflammation and insulin resis-tance?[J]. Front Endocrinol (Lausanne), 2024, 15: 1303338. doi:10.3389/fendo.2024.1303338. |
| [53] |
Husebye E S, Pearce S H, Krone N P, et al. Adrenal insufficiency[J]. Lancet, 2021, 397(10274): 613-629. doi:10.1016/s0140-6736(21)00136-7.
pmid: 33484633 |
| [54] | Bancos I, Hahner S, Tomlinson J, et al. Diagnosis and management of adrenal insufficiency[J]. Lancet Diabetes Endocrinol, 2015, 3(3): 216-226. doi:10.1016/s2213-8587(14)70142-1. |
| [55] |
Charmandari E, Nicolaides N C, Chrousos G P. Adrenal insufficiency[J]. Lancet, 2014, 383(9935): 2152-2167. doi:10.1016/s0140-6736(13)61684-0.
pmid: 24503135 |
| [56] | Gligorijevic N, Kaljevic M, Radovanovic N, et al. Adrenal Abscesses: A Systematic Review of the Literature[J]. J Clin Med, 2023, 12(14): 4601. doi:10.3390/jcm12144601. |
| [57] | Çamtosun E, Sangün Ö. Treatment and Prevention of Adrenal Crisis and Family Education[J]. J Clin Res Pediatr Endocrinol, 2025, 17(Suppl 1): 80-92. doi:10.4274/jcrpe.galenos.2024.2024-6-12-S. |
| [58] | Guo Y K, Yang Z G, Li Y, et al. Addison’s disease due to adrenal tuberculosis: contrast-enhanced CT features and clinical duration correlation[J]. Eur J Radiol, 2007, 62(1): 126-131. doi:10.1016/j.ejrad.2006.11.025. |
| [59] | Tobaiqi M A, Alshamrani M N, Sriram S, et al. Interferon-Gamma Release Assays Versus Tuberculin Skin Test for Active Tuberculosis Diagnosis: A Systematic Review and Diagnostic Meta-Analysis[J]. Diagnostics (Basel), 2025, 15(18): 2343. doi:10.3390/diagnostics15182343. |
| [60] |
Sarkar M, Sarkar J. Therapeutic drug monitoring in tuberculosis[J]. Eur J Clin Pharmacol, 2024, 80(11): 1659-1684. doi:10.1007/s00228-024-03749-8.
pmid: 39240337 |
| [61] | Brehm T T, Terhalle E. Extrapulmonary tuberculosis[J]. Dtsch Med Wochenschr, 2023, 148(19): 1242-1249. doi:10.1055/a-1937-8186. |
| Viewed | ||||||
|
Full text |
|
|||||
|
Abstract |
|
|||||
京公安网备11010202008787号
Total visitors: Visitors of today: Now online:
This work is licensed under Creative Commons Attribution 3.0 License.
