Background: Tuberculosis (TB) is a bacterial infection that can affect many organs including the pleura, and its diagnosis is not always easy. Adenosine deaminase (ADA) has been developed and widely used for the diagnosis of tuberculosis. Objective: To determine the diagnostic utility of adenosine deaminase (ADA) in a series of 80 pleural effusions, and whether pleural ADA can replace pleural biopsy in the evaluation of suspected pleural tuberculosis. We also propose a review of the literature on the characteristics, metabolism and clinical uses of ADA for the diagnosis of pleural tuberculosis in clinical practice. Methods: This is a retrospective study of 200 patients with pleural effusion, of whom 80 patients had an adenosine deaminase assay in pleural fluid. The study was conducted at the day hospital of Moulay Youssef Hospital, CHU Ibn Sina of Rabat, during the year of 2018. Results: Among 200 patients admitted for pleurisy exploration, 80 patients had benefited from adenosine deaminase assay, 90% of pleurisies were of tubercular origin, 75% were retained on histological arguments (by pleural biopsy), while the remainder were retained in front of clinical, biological, radiological and evolutionary arguments. The median pleural ADA level was 53 IU/L. Conclusion: ADA is a rapid and precise means of detecting tuberculous pleurisy, it can be used to support the diagnosis and in particular in case of absence of histological evidence either in front of the impossibility of realization of a pleural biopsy (child, effusion of small abundance), or in front of a not contributive anatomo-pathological result.