Adrenocortical function in active and treated tuberculosis in chest clinic Ipoh Hospital
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Date
2002
Authors
A.Muthukumaru, Umadevi
Journal Title
Journal ISSN
Volume Title
Publisher
Universiti Sains Malaysia
Abstract
Tuberculosis is a well known cause of adrenal dysfunction. We assessed the
adrenocortical function in patients with tuberculosis on follow up with chest clinic in
Hospital lpoh.
The primary objective of this study which was conducted in Hospital Ipoh was to
diagnose the prevalence of adrenocorticoid dysfunction in two groups of patients namely
those treated as tuberculosis and those who have completed antituberculosis treatment
within the last 18 months.
The aims of this study include:
1. To find out the prevalence of adrenocortical dysfunction among patients with
tuberculosis currently attending chest clinic follow up in Hospital Ipoh
2. To compare adrenocortical dysfunction with the severity of tuberculosis
3. To look for any correlation with the duration of the disease
4. To compare the site of disease in the context of adrenocortical dysfunction
5. To ascertain any relationship between co morbid factors such as diabetes mellitus
and adrenocortical response
6. To correlate between Human Immunodeficiency Virus (HIV) and adrenocortical
dysfunction
7. To look at serum sodium and potassium levels and to correlate with adrenal
hypofunction as diagnosed with the synacthen test
Patients with active and treated tuberculosis were studied as well as those who
have completed treatment within the last 18 months. Involvement of the adrenal gland
was assessed by basal cortisol level and cortisol response to intravenous dose of 1. 0
ug/1.73 m2 body surface area oftetracosactrin (Synacthen, Novartis, USA).
Consecutive patients seen at the chest clinic in Hospital Ipoh from January to
Setember 2001 diagnosed as tuberculosis based on acid fast bacilli smear positive,
histopathological diagnosis, radiological as well as clinical diagnosis by a physician as
tuberculosis were eligible for entry into the study. Written consent was obtained from all
subjects after adequate explanation.
Every patient was interviewed and history was taken. The patient's follow up
notes were also u~ilized to determine baseline investigation results which included serum
sodium, serum potassium and HIV status.
Samples of venous blood were collected from patients for determination of basal
plasma cortisol levels. Venous blood was collected again at exactly 30 minutes after
intravenous injection of synacthen. The serum cortisol was assayed using the
Fluorescence Polarization Immunoassay technology.
49 patients participated in this study with 8.2% of patients having abnormal post
synacthen serum cortisol of less than 550nmol/l and 22.4% with a subnormal rise of
serum cortisol following stimulation of less than 300nmolll.
The prevalence of adrenocortical dysfunction in patients with tuberculosis in
Malaysia is higher than previously suspected. Severe tuberculosis and presence of comorbid
factors are risk factors for adrenocortical dysfunction. The low dose synacthen
test is a sensitive method to assess primary adrenocortical failure There was no definite
association with the duration of symptoms, site of disease, baseline serum sodium and
serum potassium. As the numbers of patients with HIV and extra pulmonary tuberculosis
were small it was difficult to draw a conclusion regarding any association with adrenal
hypofunction.
Description
Keywords
Tuberculosis