Barnes D J, Naraqi S, Temu P, Turtle J R
Department of Clinical Sciences, University of Papua New Guinea, Port Moresby.
Thorax. 1989 May;44(5):422-4. doi: 10.1136/thx.44.5.422.
Although tuberculosis is a recognised cause of adrenal insufficiency, little is known about adrenal function in patients with active tuberculosis. Ninety Melanesian adults with active tuberculosis (30 pulmonary, 30 miliary, 30 extrapulmonary) had adrenal function assessed prospectively before and three to four weeks after starting antituberculous chemotherapy. Basal serum cortisol concentrations were normal in 55 (61%) and raised in 35 (39%) of the subjects. No patient had a low basal cortisol concentration. After Synacthen stimulation, cortisol responses were normal in 81 (92%) of the patients and subnormal in seven (8%). After antituberculous chemotherapy the response to Synacthen stimulation was normal in all but one patient. It is concluded that adrenal dysfunction is an uncommon problem in patients with active tuberculosis, and that, contrary to recent reports, antituberculous chemotherapy regimens that include rifampicin do not have an adverse effect on adrenal function.
尽管结核病是肾上腺功能不全的公认病因，但对于活动性结核病患者的肾上腺功能却知之甚少。90名患有活动性结核病的美拉尼西亚成年人（30例肺结核、30例粟粒性结核、30例肺外结核）在开始抗结核化疗前及化疗三至四周后接受了肾上腺功能的前瞻性评估。55名（61%）受试者的基础血清皮质醇浓度正常，35名（39%）升高。没有患者基础皮质醇浓度低。促肾上腺皮质激素刺激后，81名（92%）患者的皮质醇反应正常，7名（8%）患者反应低下。抗结核化疗后，除一名患者外，所有患者对促肾上腺皮质激素刺激的反应均正常。得出的结论是，肾上腺功能障碍在活动性结核病患者中是一个不常见的问题，而且与最近的报道相反，包含利福平的抗结核化疗方案对肾上腺功能没有不良影响。
