This is a 40-years old man who presented with Addison's disease. A CT scan and then a PET/CT showed bilateral necrotic adrenal nodules. The typical differential would be metastatic disease v/s granulomatous disease.

Bilateral necrotic adrenal nodules

Since the PET/CT did not show an obvious primary neoplasm, this was likely granulomatous disease. The patient had no history of travel outside India, hence the likelihood was of tuberculosis.

The biopsy was done in the prone position, just like the previous case.

Adrenal gland biopsy in the prone position

The video below explains the procedure, the approach and the final diagnosis.

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