Sarcoidosis May Cause Adrenal Gland Insufficiency: a Case Report

Researchers at the Asahi General Hospital in Japan reported a case in which sarcoidosis caused Addison’s disease to develop, which may shed some light on this rare sarcoidosis manifestation. Their study, “Sarcoidosis Presenting Addison’s Disease,” was published in the journal Internal Medicine.

Sarcoidosis is a multi-organ system condition that commonly affects the lungs, lymph nodes, skin and/or heart, but that can also involve other organs, such as the kidney, liver, joints, or endocrine glands. Although rare, sarcoidosis can be associated with Addison’s disease, which results from the disruption of the adrenal glands.

The researchers presented the case of a 52-year old Japanese man who experienced muscle pain in the limbs, cough, fatigue, and loss of appetite. During his examination, physicians found he was barely able to walk and had a brown-colored pigmentation on his skin.

The patient was diagnosed with sarcoidosis based on clinical and laboratory findings, including the presence of bilateral hilar lymphadenopathy, detected both with chest X-ray and high-resolution computed tomography (CT) scan of the lungs. Sarcoidosis diagnosis was also based on elevated levels of angiotensin-converting enzyme and lysozyme, and the presence of non-necrotizing granulomas, all of which are hallmarks of sarcoidosis.

However, the exhibition of abnormal symptoms such as general fatigue, pigmentation, weight loss, low blood pressure, and low sodium levels suggested chronic adrenocortical insufficiency and led to the patient’s admission to the hospital for further examination.

Endocrine examination of the levels of adrenocorticotropic hormone (ACTH), cortisol, aldosterone, and pituitary hormones all led to the diagnosis of primary adrenocortical insufficiency, or Addison’s disease.

As other possible causes of Addison’s disease were excluded, including autoimmune endocrine disease and autoimmune polyglandular syndrome type 2, or hypopituitarism due to sarcoidosis, the physicians concluded that the adrenocortical insufficiency was caused by a granuloma in the adrenal glands.

However, when the patient started prednisolone, followed by a combination of prednisolone and risperidone, his sarcoidosis-related exams were back to normal, but the adrenocortical deficiency did not recover, which the researchers believe may have been a consequence of extensive impairment of the adrenal glands.

The researchers also found that positron emission tomography (PET) with 18fluorodeoxyglucose (18FDG)/CT may be a useful tool for identifying extra-thoracic sarcoidosis lesions, as they were able to used the technique to identify lesions in the left lower legs without any symptoms. This may be helpful in future cases, as this tool can safely and accurately determine biopsy sites for a proper sarcoidosis diagnosis.