Bilateral adrenocortical carcinoma presenting as acute adrenal insufficiency with co-existing active pulmonary tuberculosis: A diagnostic dilemma

We report a case of a 58-year-old male patient presenting in a state of drowsiness with recurrent hiccups who was found to have hypotension and hyponatremia. He was found to have bilateral adrenal masses with peripheral rim enhancement and central necrotic destruction on contrast enhanced computerized tomography scan of abdomen which accounted for the presentation of acute adrenal insufficiency. Histopathological examination of the adrenal mass was reported as bilateral adrenocortical carcinoma. He also revealed evidences of sputum-positive active pulmonary tuberculosis in absence of any lung mass. Bilateral adrenal mass is an extremely rare condition in its own right and co-existence of such pathological condition with tuberculosis both of which can predispose to acute adrenal crisis, is even rarer. This report emphasizes the need for histopathological diagnosis in every patient of adrenal mass as presumptions can potentially lead to fatal errors.