Recovery of adrenal reserve following treatment of disseminated South American blastomycosis.

South American blastomycosis commonly involves the adrenal glands as proved in autopsy series, although clinical adrenocortical insufficiency is infrequently suspected. In 1972, an Ecuadorian man was seen with disseminated paracoccidioidomycosis and Addison's disease documented by low basal steroid levels and lack of response to ACTH therapy. The patient has since been treated with a total dose of 4,000 mg of amphotericin B. He discontinued all steroid replacement therapy for two years but remained asymptomatic. Recent evaluation documented improvement in basal steroid production, particularly mineralocorticoids. Adrenal reserve has also been demonstrated by the response of glucocorticoids to ACTH stimulation. This is the first well documented case in which adrenal reserve was recovered following treatment of granulomatous Addison's disease.