Metastatic disease was considered, especially given bilateral adrenal involvement, but the presence of pulmonary cavitation, night sweats, and positive TB cultures made disseminated TB the most unifying diagnosis. Although ACTH measurement was unavailable due to prior immunosuppressant therapy, the combination of low cortisol, characteristic clinical and imaging findings, and positive Mycobacterium tuberculosis cultures confirmed the diagnosis of primary adrenal insufficiency due to adrenal TB. Here, POMC is linked to tuberculosis.