Abstract
Addison’s disease was frequently consequent upon affectation of the glands by tuberculosis. Pulmonary Tuberculosis (PTB) is still very common in Nigeria but no report on the functional status of the adrenal cortex in patients with PTB in Nigeria exists. It is very important to note that subclinical adrenocortical failure in tuberculosis is an entity that should be considered as cortisol deficiency could be responsible for unexpected sudden death in this category of patients. This study sets out to determine the prevalence of subclinical adrenocortical failure in persons with PTB by determining the response to low-dose (1μg) ACTH stimulation. Forty four persons with newly diagnosed sputum-positive PTB and treatment naive, (23 males and 21 females, mean age 34.4±11.3 years, and mean Body Mass Index (BMI) of 18.9±2.9 kg/m2 ) completed the study. Of the one hundred healthy volunteers recruited as control subjects, 70 persons (35 males and 35 females, mean age 38.1±12.5 years, BMI 24.1±3.7kg/m2 ) completed the exercise. There was no statistically significant difference in the basal cortisol of healthy subjects and persons with PTB (239.9 vs 229.1nmol/L, p=0.661). The thirty minute response to ACTH stimulation test and increment were significantly lower in persons with PTB than in healthy subjects. Adrenocortical insufficiency, mostly at the subclinical level, is common in persons with PTB infection, occurring in about 23% of patients. We therefore recommend that basal cortisol levels should not be used to detect adrenocortical insufficiency; rather stimulation tests should be used to exclude or confirm suspected adrenocortical insufficiency in patients with PTB.
Keywords: Cortisol; adrenocorticotropic hormone (ACTH); hypothalamo-pituitary-adrenal (HPA); pulmonary tuberculosis; Nigerians.
Résumé
La maladie d’Addison était fréquemment la conséquence de l’infection des glandes par la tuberculose. La tuberculose pulmonaire (TP) est encore très commune au Nigeria mais pas le rapport dans le statut fonctionnel des glandes surrénales chez les patients ayant la tuberculose pulmonaire; il est important de noter que le défaillance adrenocorticales subclinique chez les tuberculeux est une entité qui doit être considérée comme une déficience des cortisols et pourrait être responsable d’une mort subite chez cette catégorie de patients. Cette étude est menée pour déterminer la prévalence des défaillances adrenocorticales subcliniques chez des personnes soufrant de tuberculose pulmonaire en déterminant les réactions aux faibles doses (1ìg) ACTH de stimulation. Quarante quatre personnes avec des nouveaux diagnostics positifs au PTB, (23 males and 21 femelles, une moyenne d’âge de 34.4±11.3 ans, and la moyennes d’indice de masse corporelle (IMC) de 18.9±2.9 kg/m2 ) complétait l’étude. Des 100 volontaires en bonne santé recrutés comme sujets control, 70 personnes (35 males and 35 femelles, moyenne d’âge 38.1±12.5 ans, BMI 24.1±3.7kg/m2
) complétait l’exercice. Il n’y avait statistiquement pas de différence significative sur le cortisol de base des sujets en bonne santé et ceux des personnes atteint de tuberculose pulmonaire (239.9 vs 229.1nmol/L, p=0.661). Les trente minutes de réaction au test de stimulation d’ACTH et de l’incrément étaient significativement plus bas chez les personnes atteint de tuberculose pulmonaire que chez ceux en bonne santé. L’insuffisance adrenocorticale, le plus souvent à un stade Clinique, est fréquente chez les personnes atteintes de tuberculose pulmonaire, survenant chez environs 23% des patients. Nous recommandons cependant que le niveau du cortisol de base ne soit pas utilisé pour détecter l’insuffisance adrenocorticale. Les tests de stimulation devraient plutôt être utilisés pour exclure ou confirmer l’insuffisance adrenocorticale chez les patients atteint de tuberculose pulmonaire.
Correspondence: Dr. IA Odeniyi, Department of Medicine, Lagos University Teaching Hospital, PMB 12003, Surulere, Lagos, Nigeria. Email: ifeode@yahoo.com.
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