Department of Medicine, Endocrinology Unit, University College Hospital, Ibadan, Nigeria.
Department of Medicine, Pulmonology Unit, Evercare Hospital, Lekki, Lagos, Nigeria.
Int J Mycobacteriol. 2021 Jan-Mar;10(1):1-7. doi: 10.4103/ijmy.ijmy_4_21.
Tuberculosis (TB) is a disease of public health importance globally. The incidence of pulmonary TB is rising in sub-Saharan Africa. Bilateral adrenal destruction and the use of medications such as rifampicin are possible mechanisms by which TB cause adrenal insufficiency. Failure to promptly recognize adrenal insufficiency may lead to a medical crisis causing death. This systematic review aimed to identify the frequency of adrenal insufficiency, the clinical presentation and its predictors in patients with pulmonary TB in sub-Saharan Africa.
The study was a systematic review. Medical databases and the grey literature were searched. Literature search and studies selection were done following the PRISMA guidelines.
The total sample size was 809. The frequency of adrenal insufficiency among patients with pulmonary TB in sub-Saharan Africa was 0.9%-59.8%. Patients with adrenal insufficiency had symptoms such as nausea, vomiting, darkening of the skin, salt craving, and weight loss. Other symptoms were dry, itchy skin, abdominal pain, and muscle pain. The predictors of adrenal insufficiency among patients with pulmonary TB in sub-Saharan Africa were low blood pressure, low blood glucose, presence of multidrug-resistant TB, and low CD4 count. Other predictors were abdominal pain and generalized skin hyperpigmentation.
The frequency of adrenal insufficiency in patients with pulmonary TB can be as high as 50%. The presence of low blood pressure, low blood glucose, multidrug-resistant TB, and generalized skin hyperpigmentation is a pointer to the possibility of adrenal insufficiency in these patients.
结核病（TB）是一种具有全球公共卫生重要性的疾病。撒哈拉以南非洲的肺结核发病率正在上升。双侧肾上腺破坏以及利福平等药物的使用可能是结核病导致肾上腺功能不全的机制。未能及时识别肾上腺功能不全可能导致导致死亡的医疗危机。本系统评价旨在确定撒哈拉以南非洲肺结核患者肾上腺功能不全的频率、临床表现及其预测因素。
本研究为系统评价。检索了医学数据库和灰色文献。文献检索和研究选择均遵循 PRISMA 指南进行。
总样本量为 809 例。撒哈拉以南非洲肺结核患者肾上腺功能不全的频率为 0.9%-59.8%。肾上腺功能不全的患者有恶心、呕吐、皮肤变黑、嗜盐和体重减轻等症状。其他症状还有皮肤干燥、瘙痒、腹痛和肌肉疼痛。撒哈拉以南非洲肺结核患者肾上腺功能不全的预测因素有低血压、低血糖、耐多药结核病和低 CD4 计数。其他预测因素有腹痛和全身皮肤色素沉着过度。
肺结核患者肾上腺功能不全的频率可能高达 50%。存在低血压、低血糖、耐多药结核病和全身皮肤色素沉着过度是这些患者发生肾上腺功能不全的可能性的提示。
