Probable Primary Adrenal Insufficiency Associated With Granulomatous Adrenal Calcifications, Non-tuberculous Mycobacterial Ileitis, and Crohn's Disease: A Case Report.

Granulomatous adrenal involvement is an uncommon cause of primary adrenal dysfunction, while intestinal non-tuberculous mycobacterial (NTM) infection and Crohn's disease share substantial clinical, endoscopic, radiological, and histopathological overlap. The coexistence of these entities represents an exceptional diagnostic challenge, and epidemiological data regarding their association are currently lacking. We report the case of a 61-year-old man who presented with progressive cutaneous hyperpigmentation. Computed tomography demonstrated bilateral adrenal calcifications, calcified lymph nodes suggestive of granulomatous disease, and a calcified hepatic granuloma. Biochemical evaluation revealed markedly elevated adrenocorticotropic hormone (ACTH) levels, while morning cortisol and aldosterone.