Jacob Jubbin Jagan, Paul Preethi Anni Mercy
Professor and Head, Endocrinology and Diabetes Unit, Christian Medical College and Hospital, Ludhiana 141008, Punjab, India
Associate Professor, Pathology, Christian Medical College and Hospital, Ludhiana 141008, Punjab, India
Mycobacterium tuberculosis, the etiological agent of tuberculosis (TB), is responsible for the largest number of deaths worldwide caused by a single organism. Over 25% of the world population is infected with M. tuberculosis, though active infections account only for a small percentage. Though some degree of endocrine dysfunction is invariable in all patients with TB, clinically significant endocrinopathy other than glucose intolerance is rare. This chapter reviews endocrine dysfunction and endocrinopathies associated with TB infection related to the adrenal, thyroid and pituitary glands. Additionally, functional derangement of sodium and calcium homeostasis is also covered. Adrenal involvement can be found in up to 6% of patients with active TB, however isolated adrenal involvement is seen only in a fourth of these. The most common clinical manifestation is Addison’s disease (AD). Clinical manifestations of AD appear only after 90% of the adrenal cortices have been compromised. Thyroid tuberculosis (TTB) is very rare, even in countries with a high prevalence of TB. TB has been seen to involve the thyroid in 0.1 to 1% of patients. Primary pituitary TB (in the absence of systemic involvement and/or constitutional symptoms) is extremely rare, and secondary pituitary TB is more commonly encountered in clinical practice. Pituitary TB should be considered in the differential of a suprasellar mass especially in developing countries, as the condition is potentially curable with treatment. Hyponatremia has been commonly seen in patients admitted to the hospital with TB. The commonest cause of hyponatremia is the syndrome of inappropriate antidiuresis (SIAD). Other causes include untreated primary or secondary adrenal insufficiency, volume depletion, hyponatremia associated with volume excess and hypoalbuminemia and rare cases of cerebral salt wasting seen with tuberculous meningitis. The prevalence of hypercalcemia in patients with TB has ranged from 2-51% in various studies. The primary determinant in the development of hypercalcemia among patients with TB appears to be their Vitamin D status and nutritional calcium intake. For complete coverage of all related areas of Endocrinology, please visit our on-line FREE web-text, WWW.ENDOTEXT.ORG.
结核分枝杆菌是结核病（TB）的病原体，是全球由单一病原体导致死亡人数最多的病菌。超过25%的世界人口感染了结核分枝杆菌，不过活动性感染仅占小部分。虽然所有结核病患者都会出现一定程度的内分泌功能障碍，但除葡萄糖不耐受外，具有临床意义的内分泌病很少见。本章回顾了与结核分枝杆菌感染相关的肾上腺、甲状腺和垂体的内分泌功能障碍及内分泌病。此外，还涵盖了钠和钙稳态的功能紊乱。活动性结核病患者中高达6%可出现肾上腺受累，但其中仅有四分之一为孤立性肾上腺受累。最常见的临床表现是艾迪生病（AD）。AD的临床表现仅在90%的肾上腺皮质受损后才会出现。甲状腺结核（TTB）非常罕见，即使在结核病高发国家也是如此。结核病患者中甲状腺受累的比例为0.1%至1%。原发性垂体结核（在无全身受累和/或全身症状的情况下）极为罕见，继发性垂体结核在临床实践中更常见。在鉴别鞍上肿块时应考虑垂体结核，尤其是在发展中国家，因为该病经治疗可能治愈。低钠血症在因结核病住院的患者中很常见。低钠血症最常见的原因是抗利尿激素分泌失调综合征（SIAD）。其他原因包括未治疗的原发性或继发性肾上腺功能不全、容量耗竭、与容量过多和低白蛋白血症相关的低钠血症，以及结核性脑膜炎所见的罕见脑性盐耗竭病例。在各项研究中，结核病患者高钙血症的患病率在2%至51%之间。结核病患者发生高钙血症的主要决定因素似乎是其维生素D状态和营养性钙摄入量。欲全面了解内分泌学的所有相关领域，请访问我们的在线免费网络文本，网址为WWW.ENDOTEXT.ORG。
