Ronik Kanani and Aleixo Muise1 de-scribe a case of intra-abdominal peritonitis associated with abdominal pain and hypotension secondary to intra-abdominal tuberculosis (TB). The clinical presentation in this case is suspicious for adrenal insufficiency. TB is one of the leading causes of adrenal insufficiency worldwide, but the presence of TB may be difficult to diagnose. In a large retrospective study of autopsy results in Hong Kong, Lam and Lo2 found active TB in 6.5% of cases; however, in more than 70% of these patients, TB was diagnosed only at autopsy. Adrenal insufficiency was found in 6% of the patients with active TB. It may also be difficult to identify TB as the cause of adrenal insufficiency, as illustrated by Serter and associates.