Tuberculosis of the organs of the endocrine system

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

With the spread and deepening of the tuberculosis process, it is possible to note the oppression of adaptation mechanisms, and with it the decrease in the level of many hormones in the blood. The response depends largely on the initial state of the organism, concomitant diseases, genetically determined and immunological responses, which basically determines the quality of local tissue reactions in the field 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 gland, thyroid gland and pituitary gland. For tuberculosis organs of the endocrine system is characterized by:

• primary damage by hematogenous way;
• multiple localization of the active specific process.

Among the diagnostic tests for tuberculosis of the endocrine system organs, it is necessary to include tuberculin diagnostics and the search for specific antibodies in the blood plasma (serological reactions with tuberculosis antigen): the PCR method can be used to detect tubercle bacilli in the blood.

Lymphogenous and contact damage to the organs of the endocrine system is rarely observed. An example is the development of tuberculosis of the pituitary gland in tuberculous meningitis. There are cases of isolated damage to the adrenal and thyroid gland.

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

Adrenal Tuberculosis

Most adrenal hypofunction is due to 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%).

[1], [2], [3], [4], [5], [6], [7], [8]

Symptoms of adrenal tuberculosis

With tuberculosis of the adrenal glands, both in the cortex and in the medulla layer, specific foci of curdled necrosis are revealed. In this case, local fibrotic 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 tuberculosis process in the adrenal gland begins, as a rule, with the first symptoms of adrenal insufficiency:

• weakness, increased fatigue;
• increased pigmentation of the skin, especially on the bending surfaces;
• in 15% of cases with a combination of hyperpigmentation with depigmentation sites;
• 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, the content of cortisol in the blood can be determined. With a true adrenal lesion, the magnitude of this indicator is significantly reduced and becomes much lower than normal.

Instrumental methods of research, such as ultrasound and CT, allow to see infiltrates and foci of necrosis with a size of 6 mm or more. In full patients it is better to use CT as the possibilities of ultrasound in these cases are limited. In recent years, great importance is attached to MRI.

[9]

Tuberculosis of the thyroid gland

Symptoms of Tuberculosis of the Thyroid Gland

Clinically manifested tuberculosis of the thyroid gland is very rare. Specific lesion of the thyroid gland is detected accidentally with a biopsy, associated with the identification of a "cold" node in its structure.

For the tuberculous abscess of the thyroid gland, the following symptoms are typical :

• 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, choking.

Diagnosis of Thyroid Tuberculosis

To establish the diagnosis without conducting histological studies is almost impossible. Currently, ultrasound and radioisotope scanning of the thyroid gland are performed, with the help of which only the infiltration site can be determined. Calcification of the thyroid gland is extremely rare. When forming a fistula with a discharge from a cold abscess, it is advisable to carry out bacterioscopic and bacteriological studies aimed at finding mycobacteria of tuberculosis. Differential diagnosis is carried out with diseases in which "cold" nodes are formed.

[10], [11], [12], [13], [14]

Tuberculosis of the hypothalamus and pituitary gland

Epidemiology of tuberculosis of the hypothalamus and pituitary gland

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

[15], [16]

Diagnosis of tuberculosis of the hypothalamus and pituitary gland

Diagnosis and differential diagnosis of tuberculosis of the hypothalamus and pituitary gland are extremely difficult. Intravital verification of tuberculosis defeat of the pituitary gland is possible only with widespread tuberculosis, when signs of pituitary function deficiency appear. The most important and most striking of these is diabetes insipidus (diabetes insipidus); less often, when the inflammatory process goes beyond the pituitary gland or the pituitary gland increases in size, it is possible to damage the optic nerves in the region of the chiasma.

[17], [18], [19], [20]