PURPOSE: Although adrenal insufficiency in tuberculosis is mostly caused by adrenal tuberculosis, it may occur without direct adrenal involvement. During antituberculous treatment, enhanced metabolism of adrenal hormones also can be the cause of adrenal insufficiency. It is not known that subclinical adrenal insufficiency in tuberculosis without direct adrenal involvement could make some differences in clinial progress.
METHODS: Adrenal functions before and after antituberculous treatment and clinical courses were evaluated prospectivly in patients with respiratory tuberculosis. In 16 patients (male 8, mean age 56) with respiratory tuberculsis (12 pulmonary tuberculois, 4 tuberculous pleurisy), adrenal function test (rapid ACTH stimulation test; serum cortisol level at basal, 30 minutes and 60 minutes after Synacthen 250 μg intramuscular injection) was done before and after one week of 1st line antituberculosis chemotherapy.
RESULTS: Mean follow up duration was 6 months. Maximal serum cortisol level and cortisol increment after Synacthen injection were 26.4±6.8 μg/dL and 7.8±5.3 μg/dL before antituberculous chemotherapy and 27.1±5.1 μg/dL and 8.9±5.1 μg/dL after one week of treatment. (p>0.05) There were no significant differences in laboratory findings and clinical courses between patients with cortisol increment more than 7 μg/dL (n=8) and less than 7 μg/dL (n=8) before treatment. Paradoxical responses occurred in 3 patients, whose cortisol increments were all less than 7 μg/dL.
CONCLUSION: Cortisol responses to Synacthen were decreased in half patients with respiratory tuberculosis. Paradoxical responses occurred in patients with decreased cortisol response to Synacthen.
CLINICAL IMPLICATIONS: Decreased cortisol increment to Synacthen injection before antituberculosis treatment can be the risk factor for the development of paradoxical response in respiratory tuberculosis.
DISCLOSURE: Byoung Lee, None.