Addison disease

Granulomatous Infection (Tuberculosis) is the most common infectious cause of Addison disease. CT appearance of granulomatous infection depends on the time and activity of the inflammatory process. 

• early stage “adrenalitis” include bilateral adrenal enlargement with a central necrotic area of hypoattenuation and a peripheral enhancing rim.
• In the healing stage of the disease, the adrenal glands become calcified and atrophic (adrenal calcification).

Addison disease may be either acute, subacute,or chronic (62).

• Acute Addison disease occurs within a few weeks to months and is caused by bilateral adrenal hemorrhage (adrenal apoplexy), secondary to shock and sepsis or trauma. On CT scan bilateral adrenal hematomas are demonstrated. 
• Subacute disease (adrenalitis): when the disease has been present for less than 2 years. On CT enlargement of both adrenal glands, with necrotic centers and a rim of contrast enhancement are usually demonstrated. CT-guided biopsy helps to identifiy the cause such as tuberculosis, histoplasmosis, and other fungi. 
• Chronic disease: may be caused by chronic autoimmune disorder, chronic granulomatous infection (TB or histoplasmosis). On CT both adrenal glands appear small and atrophic with assciaatedassociated with calcifications in granulomatous adrenalitis.