Global patterns and clinical outcomes of endocrine gland involvement in tuberculosis: A comprehensive mini-review

Background: Tuberculosis (TB) remains a significant global health challenge, particularly in low- and middle-income countries where extrapulmonary forms—including endocrine gland involvement—often go unrecognized. Endocrine tuberculosis (ETB) can affect the adrenal, pituitary, thyroid, and gonadal glands, typically presenting with nonspecific symptoms that mimic tumors or autoimmune disorders. Emerging literature highlights the importance of timely diagnosis and treatment in preserving endocrine function.

Objective: To summarize the global prevalence, clinical features, pathophysiological mechanisms, therapeutic response, and hormonal outcomes of tuberculosis involving major endocrine glands, based on validated research published between 2000 and 2025.

Methods: A structured narrative mini review was conducted following PRISMA principles. Systematic literature searches were performed in PubMed, Scopus, and Google Scholar using combinations of keywords and Mesh terms related to “tuberculosis,” “endocrine,” “adrenal,” “pituitary,” “thyroid,” and “gonads.” Eligible articles included original peer-reviewed studies, reviews, and case series (n ≥ 3) published between 2000 and 2025 in English. Studies were selected if they reported endocrine TB involvement with clinical manifestations, hormonal effects, therapeutic interventions, and outcomes. From 164 screened abstracts, 72 full-text articles were reviewed, and 45 high-quality studies (Newcastle-Ottawa score ≥6) were included. Data were organized by glandular site, clinical effect, treatment modality, and reversibility.

Results: Adrenal TB was the most frequently reported (42%), typically presenting as primary adrenal insufficiency. Biochemical recovery was observed in 80–90% of patients treated early with anti-tuberculous therapy (ATT), while irreversible cases required lifelong steroid therapy. Pituitary TB (29%) frequently mimicked seller tumors, leading to panhypopituitarism or diabetes insipidus; hormonal improvement was noted in 60–75% of early-treated cases. Thyroid TB (17%) often resembled malignancy or multinodular goiter; surgical excision with ATT led to functional restoration in most cases. Gonadal involvement (12%) presented as pubertal delay or hypogonadism, primarily secondary to hypothalamic-pituitary axis disruption, with pediatric patients demonstrating good recovery following therapy. Pathophysiological mechanisms included hematogenous dissemination, granulomatous inflammation, and immune reconstitution inflammatory syndrome (IRIS), particularly in immunocompromised hosts. Prognosis correlated strongly with diagnostic timing, degree of tissue necrosis, and comorbidities such as HIV. The most severe presentations were noted in sub-Saharan Africa and South Asia, reflecting healthcare disparities and delayed diagnosis.

Conclusions: Although often underdiagnosed, endocrine tuberculosis has substantial clinical implications. Adrenal and pituitary glands are most commonly involved. With early detection and appropriate therapy, most endocrine dysfunctions are reversible. Enhanced awareness, interdisciplinary care, and long-term follow-up are vital for improving outcomes, especially in TB-endemic regions.