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The spectrum of endocrine dysfunction in active pulmonary tuberculosis
Author(s) -
Post F. A.,
Soule S. G.,
Willcox P. A.,
Levitt N. S.
Publication year - 1994
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/j.1365-2265.1994.tb03933.x
Subject(s) - medicine , basal (medicine) , endocrinology , euthyroid , thyroid function , acth stimulation test , prospective cohort study , endocrine system , hypogonadotrophic hypogonadism , body mass index , thyroid , hormone , adrenocorticotropic hormone , diabetes mellitus
Summary OBJECTIVE Substantial variation in the prevalence (0–55%) of hypoadrenalism in tuberculosis (TB) has been reported. The aim of this study was to prospectively evaluate adrenal, thyroid and gonadal function in patients presenting with active pulmonary TB. DESIGN A prospective study of 50 patients admitted to a single hospital. PATIENTS Fifty hospitalized adults with newly diagnosed sputum positive pulmonary TB (mean age 38 years, mean body mass index 18 kg/m 2 , mean albumin 28 g/l) were studied. MEASUREMENTS Adrenal reserve was assessed by intravenous tetracosactrin administration with measurement of basal and stimulated cortisol concentrations. Basal ACTH, thyroid and gonadal hormones were also measured. RESULTS The mean basal serum cortisol was 625 nmol/l (range 394–1185). Basal plasma ACTH was undetectable (<4·4 pmol/l) in 32, normal in 17 (mean 11·45, range 4·4–24.9 pmol/l) and elevated in one (54·2 pmol/l) subjects and did not correlate with cortisol. The mean increment in cortisol following tetracosactrin was 256 nmol/l (range 0–650) and was unrelated to basal cortisol or ACTH. All 50 patients had a stimulated plasma cortisol exceeding 550 nmol/l, indicating intact adrenal reserve. Ninety‐two per cent of patients had the sick euthyroid syndrome, 72% of males had hypogonadotrophic hypogonadism and 4% of patients tested positive for the human immunodeficiency virus. CONCLUSIONS Hypoadrenalism is uncommon in active pulmonary TB despite frequent dysfunction of the thyroid and gonadal axes.