In developing countries tuberculosis is a common cause of constrictive pericarditis and its Involvement of other organs may sometimes complicate the surgical management of such patients. A case is reported of constrictive pericarditis in which the patient developed protracted hypotension which was unresponsive to inotropic therapy, following pericardiectomy. On investigation the cause of hypotension was diagnosed as acute adrenocortical insufficiency, secondary to adrenal tuberculosis. The patient was successfully treated with corticosteroids. Low cardiac output after pericardiectomy, which is not uncommon, should not necessarily be attributed to a ‘myocardial factor’. Patients with tuberculous pericarditis may have co-existent Addison's disease.