Tuberculosis of endocrine organs

The endocrine system carries out humoral regulation of the functions of all organs and systems, maintaining homeostasis in the body. Tuberculosis of the endocrine system organs, as with other diseases, is accompanied by a change in the internal environment, and each link of the endocrine system reacts to this "irritant" in its own way. Thus, an increase in the level of hormones of the thyroid gland and the sympathoadrenal system is observed.

As the tuberculosis process spreads and deepens, one can note the suppression of adaptation mechanisms, and along with this, a decrease in the level of many hormones in the blood. The response largely depends on the initial state of the body, concomitant diseases, genetically determined and immunological responses, which mainly determines the quality of local tissue reactions in the area of specific pathological changes. In recent years, the work of the APUD system in patients with tuberculosis has been studied, since changes in this system also largely determine the clinical course of the disease. This section highlights the features of tuberculous changes in the adrenal glands, thyroid gland and pituitary gland. Tuberculosis of the endocrine system is characterized by:

• predominantly hematogenous infection;
• multiple localization of an active specific process.

Diagnostic tests for tuberculosis of the endocrine system organs necessarily include tuberculin diagnostics and the search for specific antibodies in the blood plasma (serological reactions with the tuberculosis antigen): the PCR method can be used to detect tuberculosis mycobacteria in the blood.

Lymphogenic and contact lesions of the endocrine system organs are rare. An example is the development of pituitary tuberculosis in tuberculous meningitis. There are known cases of isolated lesions of the adrenal glands and thyroid gland.

A group of researchers, conducting an autopsy of 100 people who died from disseminated tuberculosis, discovered signs of a specific process in the adrenal glands in 53%, in the thyroid gland in 14%, in the testicles in 5%, and in the pituitary gland in 4% of cases.

Tuberculosis of the adrenal glands

Most often, adrenal hypofunction is caused by diffuse atrophy (up to 60% of cases), mainly of autoimmune origin, and tuberculosis (up to 30%), as well as amyloidosis and other diseases (up to 10%).

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Symptoms of adrenal tuberculosis

In tuberculosis of the adrenal glands, specific foci of caseous necrosis are detected in both the cortex and the medulla. In this case, local fibrous changes are formed, calcium deposits appear. At the same time, only a small proportion of patients are diagnosed with adrenal insufficiency, the clinical signs of which appear when more than 90% of the gland tissue is destroyed.

Diagnosis of the tuberculous process in the adrenal glands usually begins with the first symptoms of adrenal insufficiency:

• weakness, increased fatigue;
• increased skin pigmentation, especially on the flexural surfaces;
• in 15% of cases with a combination of hyperpigmentation and areas of depigmentation;
• lowering blood pressure;
• dysfunction of the digestive tract, constipation;
• myocardial dystrophy;
• hypoglycemic conditions;
• increased desire to consume salt;
• arthralgia.

Diagnosis of adrenal tuberculosis

With the help of modern research, it is possible to determine the content of cortisol in the blood. In case of true damage to the adrenal glands, the value of this indicator is significantly reduced and becomes much lower than normal.

Instrumental methods of examination, such as ultrasound and CT, allow us to see infiltrates and necrosis foci of 6 mm or more in size. In obese patients, it is better to use CT, since the capabilities of ultrasound in these cases are limited. In recent years, MRI has been given great importance.

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Thyroid tuberculosis

Symptoms of thyroid tuberculosis

Clinically manifested thyroid tuberculosis is observed very rarely. Specific thyroid lesions are discovered accidentally during biopsy associated with the detection of a "cold" node in its structure.

The following symptoms are characteristic of a tuberculous thyroid abscess:

• pain in the front of the neck, especially when swallowing:
• weakness, fatigue, malaise;
• local symptoms of the inflammatory process in the thyroid gland - the so-called "close symptoms": dysphagia, hoarseness, suffocation.

Diagnosis of thyroid tuberculosis

It is almost impossible to establish a diagnosis without histological examination. Currently, ultrasound and radioisotope scanning of the thyroid gland are performed, with the help of which it is possible to determine only the area of infiltration. Thyroid calcifications are extremely rare. When a fistula with discharge from a cold abscess is formed, it is advisable to conduct bacterioscopic and bacteriological studies aimed at finding mycobacteria tuberculosis. Differential diagnostics are carried out with diseases in which "cold" nodes are formed.

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Tuberculosis of the hypothalamus and pituitary gland

Epidemiology of tuberculosis of the hypothalamus and pituitary gland

In world practice, only a few cases of damage to the pituitary gland and hypothalamus by the tuberculous process have been described. All authors point to the connection of tuberculosis of this localization with tuberculous meningitis and hematogenous (miliary) tuberculosis.

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Diagnosis of tuberculosis of the hypothalamus and pituitary gland

Diagnosis and differential diagnosis of hypothalamic and pituitary tuberculosis are extremely difficult. Lifetime verification of tuberculous pituitary lesions is possible only in the case of widespread tuberculosis, when signs of pituitary insufficiency occur. The most important and most striking of these is considered to be diabetes insipidus; less often, when the inflammatory process extends beyond the pituitary gland or the pituitary gland increases in size, damage to the optic nerves in the chiasm region is possible.

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