Tuberculosis with adrenal insufficiency mimicking malignancy in FDG-PET images

Abstract

Addison’s disease may result from adrenal tuberculosis (TB), malignancy, idiopathic adrenal atrophy, blastomycosis or histoplasmosis. Thus, adrenal masses are often characterized by fluorine-18 fluoro-2-deoxy-D-glucose positron emission tomography (18F FDG-PET), which identifies tumors by their increased glucose metabolism. However, a large number of clinical conditions lead to false positives in PET, often related to inflammation or infection. Herein, we present a patient with adrenal insufficiency associated with bilateral masses and a history of TB. We identified elevated FDG uptake in both adrenal glands that could not be differentiated from primary bilateral adrenal lymphoma or other malignancies. Following adrenalectomy, a final diagnosis of adrenal TB was made. This uncommon case emphasizes that benign adrenal lesions can have increased FDG uptake leading to false-positive results. © 2016, Nobelmedicus. All rights reserved.