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A Study of Adrenocortical Function in Patients with Pulmonary Tuberculosis and its Response to Anti Tubercular Therapy(ATT).
J Assoc Physicians India. 2022 Apr;70(4):11-12.
Mandya Institute of Medical Sciences, Mandya, Karnataka.
J Assoc Physicians India. 2022 Apr;70(4):11-12.
Tuberculosis may lead to adrenal insufficiency by direct glandular involvement, by extra glandular infection or as a by-product of Anti tuberculous therapy. Subclinical adrenal insufficiency becomes important in stressful situation which require increased release of ACTH to meet heightened metabolic demands. Our objective was to determine the adrenal reserve in patients with pulmonary tuberculosis and to determine the effect of ATT on adrenal function.
Prospective observational study was performed on 50 pulmonary tuberculosis patients. Blood sample for baseline serum cortisol is drawn between 8:00 and 8:30 a.m. with patients fasting overnight. Patients with serum cortisol level < 220 nmol/L will be followed up by ACTH stimulation by injecting 250μg of Cosyntropin intramuscularly and blood samples for serum cortisol is drawn at 30 and 60 minutes. Serum cortisol levels < 220 nmol/L, Post-ACTH <500 nmol/L or post ACTH increment <200 nmol/L are suggestive of adrenal insufficiency. After ATT patients are followed up and tests are repeated.
The mean age group in my study is 47.1+ 11.6 with majority being male. The mean cortisol both basal and post intravenous ACTH was significantly lower in cases before ATT compared to after ATT (mean + SD basal cortisol of 367.38+164.08mmol/l before ATT vs 535.32 + 156.39 mmol/l after ATT). and post ACTH, cortisol at 30 min is 319.78 + 85.6mmol/l before ATT vs 342.5 +73.6 mmol/l after and cortisol at 60 min is 333.6429 +98.17 mmol/l before ATT vs 351 +70.8 mmol/l after ATT with the p value of 0.0092).
TB associated endocrinopathies are not infrequent. Clinically overt manifestations of these conditions are however unusual. Incidence of adrenal insufficiency in pulmonary tuberculosis patients was high, and it was confirmed with ACTH stimulation test. This present study helps identifying cases at risk of fatal adrenal crisis and institute timely management, thus improving disease prognosis.
确定肺结核患者的肾上腺储备功能，并观察抗结核治疗（ATT）对肾上腺功能的影响。
前瞻性观察性研究纳入了 50 名肺结核患者。患者空腹过夜，于上午 8：00 至 8：30 之间抽取基线血清皮质醇样本。若血清皮质醇水平 <220nmol/L，则患者接受 250μg 促皮质素（Cosyntropin）肌内注射，分别于 30 分钟和 60 分钟抽取血清皮质醇样本。若血清皮质醇水平 <220nmol/L，促皮质素刺激后皮质醇水平 <500nmol/L，或促皮质素刺激后皮质醇增加值 <200nmol/L，则提示存在肾上腺皮质功能不全。ATT 治疗后，我们对患者进行随访并重复检查。
本研究中，患者的平均年龄为 47.1+11.6 岁，其中大多数为男性。ATT 治疗前，患者的基础和静脉注射促皮质素后皮质醇水平均显著低于 ATT 治疗后（ATT 治疗前基础皮质醇的平均值+标准差为 367.38+164.08mmol/L，ATT 治疗后为 535.32+156.39mmol/L）。促皮质素刺激后 30 分钟时，ATT 治疗前的皮质醇水平为 319.78+85.6mmol/L，ATT 治疗后为 342.5+73.6mmol/L；60 分钟时，ATT 治疗前的皮质醇水平为 333.6429+98.17mmol/L，ATT 治疗后为 351+70.8mmol/L，p 值为 0.0092。
肺结核相关内分泌疾病并不少见。然而，这些疾病的临床表现通常不明显。肺结核患者中肾上腺皮质功能不全的发生率较高，且通过促皮质素刺激试验得到了证实。本研究有助于发现有发生致命性肾上腺危象风险的病例，并及时进行管理，从而改善疾病预后。
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