Adrenocortical function in active and treated tuberculosis in chest clinic Ipoh Hospital
| dc.contributor.author | A.Muthukumaru, Umadevi | |
| dc.date.accessioned | 2017-08-30T06:40:10Z | |
| dc.date.available | 2017-08-30T06:40:10Z | |
| dc.date.issued | 2002 | |
| dc.description.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. | en_US |
| dc.identifier.uri | http://hdl.handle.net/123456789/4457 | |
| dc.language.iso | en | en_US |
| dc.publisher | Universiti Sains Malaysia | en_US |
| dc.subject | Tuberculosis | en_US |
| dc.title | Adrenocortical function in active and treated tuberculosis in chest clinic Ipoh Hospital | en_US |
| dc.type | Thesis | en_US |
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