A18.7 Tuberculosis of adrenal glands

Name of the Condition

• Tuberculosis of adrenal glands
• ICD Code: A18.7

Summary

Tuberculosis of the adrenal glands is a form of extrapulmonary tuberculosis where Mycobacterium tuberculosis infects the adrenal glands. This condition occurs when TB bacteria spread from a primary site, typically the lungs, to the adrenal glands via the bloodstream or lymphatic system. It can disrupt adrenal hormone production, leading to systemic effects.

Causes

Tuberculosis of the adrenal glands is caused by the dissemination of Mycobacterium tuberculosis from an existing infection, usually pulmonary tuberculosis. The bacteria may travel to the adrenal glands during active disease or reactivation of latent TB. Direct inoculation is rare but possible in certain cases.

Risk Factors

• Immunocompromised states, such as HIV/AIDS or chronic immunosuppressive therapy.
• History of untreated or inadequately treated tuberculosis.
• Close contact with individuals who have active TB.
• Living in or traveling to regions with high TB prevalence.
• Underlying conditions like diabetes or malnutrition.

Symptoms

• Fatigue or weakness.
• Unexplained weight loss.
• Gastrointestinal symptoms (e.g., nausea, vomiting, abdominal pain).
• Electrolyte imbalances (e.g., low sodium, high potassium).
• Hypotension (low blood pressure), especially when standing.
• Hyperpigmentation of the skin in some cases.

Diagnosis

Diagnosis involves a combination of clinical evaluation, imaging (e.g., CT or MRI of the adrenal glands), and laboratory tests. Adrenal function tests may assess hormone production. Biopsy or fine-needle aspiration of the adrenal glands, followed by histopathological examination and culture, can confirm TB infection. Sputum or other samples may be tested for Mycobacterium tuberculosis if a pulmonary source is suspected.

Treatment Options

Treatment follows standard antitubercular therapy, typically a multi-drug regimen (e.g., isoniazid, rifampin, pyrazinamide, and ethambutol) for 6–9 months. Corticosteroid replacement may be necessary if adrenal insufficiency develops. Monitoring for treatment response and adrenal function is essential.

Prognosis and Follow-Up

Prognosis depends on early diagnosis, effective treatment, and the extent of adrenal damage. With appropriate therapy, many patients recover, but adrenal insufficiency may persist. Regular follow-up includes monitoring for treatment adherence, adverse effects, and adrenal function.

Complications

• Adrenal insufficiency (Addison’s disease) due to gland destruction.
• Electrolyte imbalances.
• Chronic fatigue or weakness.
• Recurrence of TB if treatment is incomplete.

Lifestyle & Prevention

• Complete the full course of antitubercular therapy as prescribed.
• Manage underlying conditions (e.g., HIV, diabetes) to reduce TB risk.
• Avoid exposure to active TB by limiting contact with infected individuals.
• Maintain good nutrition and overall health to support immune function.

When to Seek Professional Help

Seek medical attention if symptoms of adrenal insufficiency (e.g., severe fatigue, dizziness, low blood pressure) or worsening TB symptoms (e.g., persistent fever, weight loss) occur. Prompt evaluation is critical to prevent complications.

Tips for Medical Coders

Code A18.7 is used for tuberculosis specifically involving the adrenal glands. Documentation should specify the site (adrenal glands) and confirm TB infection (e.g., via culture, histology, or clinical criteria). Ensure the code aligns with the patient’s diagnosis and treatment plan. Do not use this code for non-TB adrenal infections or generalized extrapulmonary TB without adrenal involvement.