In the present study, differentiation betweenC. elevated at 1:128. To control the cryptococcosis, a laparoscopic remaining adrenalectomy was performed, followed by antifungal therapy. After the unilateral adrenalectomy, the size of the remaining ideal adrenal mass was reduced and the serum cryptococcal antigen titer declined to 1 1:4. == Conclusions == This is the first report describing adrenal cryptococcosis with adrenal insufficiency and liver invasion without central nervous system involvement. Adrenal cryptococcosis should be considered in the differential analysis for individuals with bilateral adrenal people with main adrenal deficiency. Unilateral adrenalectomy was quite effective in controlling the cryptococcosis in this case. Even in individuals with bilateral adrenal cryptococcosis, unilateral adrenalectomy should be an option for treatment of disseminated cryptococcosis. == Background == Cryptococcus neoformansis an encapsulated yeast-like fungus found in dirt and in pigeon or additional avian feces. 3-Methoxytyramine 3-Methoxytyramine Cryptococcus is definitely believed to be acquired by inhalation of fungal spores into the respiratory tract [1,2]. Since cell-mediated immune responses contribute to safety against GNG12 cryptococcus, individuals with impaired cell-mediated immunity, such as advanced AIDS or lymphoid and hematopoietic malignancies, and transplantation recipients are particularly prone to development of cryptococcosis [2-4]. Another varieties,Cryptococcus gattii, that is relevant to a recent outbreak in western North America is known to cause cryptococcosis in immunocompetent individuals [1,2,5]. Pulmonary cryptococcosis and cryptococcal meningitis are common manifestations in immunocompromised hosts. Disseminated cryptococcosis in immunocompromised hosts less frequently affects the skin, eyes, lymph nodes, bone marrow, liver, spleen, adrenal glands, kidneys, prostate, kidneys, thyroid, intestine, pancreas and ovaries [4,5]. Cryptoccocal illness of adrenal glands and liver is usually associated with involvement of the central nervous system and the lungs [2,6]. Here, we report a case of slight diabetic 43-yr male with cryptococcosis of the bilateral adrenal glands and liver with adrenal insufficiency without involvement of the lungs and central nervous system. Since long-term therapy with antifungal providers was not effective against his cryptococcosis, a unilateral adrenalectomy was performed. The sizes of both the adrenal and liver lesions were decreased after the surgery treatment followed by antifungal therapy and the serum cryptococcus antigen titer of the patient was markedly reduced from 1:256 to 1 1:4. == Case Demonstration == A 43-year-old man with slight type 2 diabetes mellitus went to the hospital where he received his medications for diabetes mellitus, owing to prolonged dizziness, anorexia and general fatigue for one month before the discussion. He showed significant weight loss of 15 kg during that 1 month. Approximately 2 weeks before the emergence of his medical symptoms, he walked around a cave where he experienced a lot of bird droppings and feathers. Since abdominal CT exposed bilateral adrenal people, 3-Methoxytyramine he was launched to a larger hospital for advanced exam. On admission, physical exam revealed a height of 167 cm and a excess weight of 62 kg. The 3-Methoxytyramine remainder of the exam findings were normal without indications of meningitis. Laboratory data included white blood cell count of 7,390/L with 61.7% neutrophils, 23.9% lymphocytes, 2.4% eosinophils, 0.5% basophils and 9.4% monocytes, hemoglobin of 12.6 g/dL and platelet count of 313,000/L. Even though serum sodium level (133 mEq/L) was slightly decreased, the serum levels of potassium, chloride, creatinine and fasting glucose were normal. The HbA1c was 6.2%. The level of -gamma glutamyl 3-Methoxytyramine transpeptidase was elevated to 116 U/L without improved levels of aspartate aminotransferase, alanine aminotransferase and alkaline phosphatase. The serum C-reactive protein level was elevated (5.04 mg/dL). On endocrinological exam, low basal serum cortisol (2.3 g/dL; normal: 4.0-18.3) with high serum adrenocorticotropic hormone (ACTH) (843 pg/mL; normal: 7.2-63.3) was observed, indicating main adrenal insufficiency. In addition to the low blood levels of aldosterone (28.5 pg/mL; normal: 38.9-307) and dehydroepiandrosterone sulfate (55 g/dL; normal: 70-495) synthesized and released from the adrenal cortex, the 24-hour urine adrenaline (1.6 g/day time: normal: 3.4-26.9) and epinephrine (< 0.01 mg/day time; normal: 0.04-0.19) levels were markedly reduced, indicating that the adrenal medulla was also devastated. Quick ACTH (Cortrosyn) activation revealed the absence of a serum cortisol response (baselines of 1 1.1 g/dL to 1 1.1 g/dL and 1.1 g/dL at 30 and 60 minutes after the ACTH challenge, respectively). Main adrenal insufficiency was diagnosed and a routine of oral hydrocortisone (20 mg/day time) was prescribed. Contrast-enhanced abdominal CT showed bilateral adrenal people (right: 5.2 2.7 cm; remaining: 3.7 3.6 cm) (Number1A). The differential analysis of the adrenal people included metastatic carcinoma, tuberculosis, fungal infections, bilateral adrenal hyperplasia and sarcoidosis. An intensive whole-body exam failed to detect a primary lesion for malignancy. The QuantiFERON-TB test and serum human being immunodeficiency disease (HIV) antibody enzyme immunoassay were negative. Re-examination of the abdominal CT at one month after admission revealed a liver.