Adrenal Histoplasmosis- Keeping a High Index of Suspicion

Adrenal histoplasmosis is the most common adrenal granulomatous infection in the endemic areas of the world including some parts of the western United States.The adrenal gland is the most common endocrine organ to be affected by histoplasmosis, but the exact mechanism of localization of histoplasmosis toadrenal glands is unclear and is thought to be contributed by paucity of reticulo endothelial cells and presence of steroids in the adrenal glands.

Even though adrenal histoplamosis was initially thought to be a disease among the immuno compromised patient population such as those with immune deficiency syndromes, diabetes, those on steroids or transplant recipients, we are now seeing more cases in patients with intact immune systems. Adrenal histoplasmosis is also being diagnosed with increasing prevalence in the non-endemic regions of the world.There have been instances when adrenal histoplasmosis presented as a unilateral adrenal mass in otherwise asymptomatic patients who were initially diagnosed as adrenal carcinoma. These patients undergo adrenalectomy for fungal infections which could have been diagnosed with biopsies or serology if the index of suspicion was higher.Read more.......