Chan C H, Arnold M, Mak T W, Chan R C, Hoheisel G B, Chow C C, Cockram C
Department of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin.
Tuber Lung Dis. 1993 Dec;74(6):395-8. doi: 10.1016/0962-8479(93)90083-a.
A regional hospital in Hong Kong.
To evaluate adrenocortical function in older patients admitted to hospital with active pulmonary tuberculosis (TB) and to determine whether adrenal insufficiency contributes to mortality in this high risk group.
Adrenocortical function was assessed in 39 consecutive patients aged over 50 admitted to hospital with active pulmonary TB. Short Synacthen stimulation tests were performed before treatment and repeated at 2 months. In patients who died during treatment, a post-mortem examination was performed. Particular attention was paid to TB involvement of the adrenal glands.
None of the patients had a subnormal basal cortisol concentration before treatment. 7 (18%) had raised basal cortisol concentrations and 16 (41%) had suboptimal cortisol responses to Synacthen stimulation. 14 patients (36%) died during treatment. The basal cortisol concentrations were significantly higher in the non-survivors compared to the survivors (743.7 +/- 288.5 vs 460.5 +/- 123.2 nmol/L, P < 0.0001). Autopsies were performed in 9 patients who died during treatment. Tuberculous involvement of the adrenal glands was found in only 1 patient who had a high basal cortisol concentration. After 2 months of treatment, all patients had normal cortisol concentrations and only 4 had borderline suboptimal Synacthen responses. The basal cortisol concentrations were significantly higher at presentation compared to those at 2 months after treatment (570.4 +/- 243.8 vs 386.3 +/- 108.3 nmol/L, P = 0.0014).
Adrenal insufficiency is uncommon in patients with pulmonary TB. Suboptimal cortisol responses to Synacthen usually reflect a hyperstimulated basal state secondary to stress. Treatment with anti-TB drugs causes reduction in basal cortisol with associated improvement in the Synacthen response.
香港一家地区医院。
评估因活动性肺结核（TB）入院的老年患者的肾上腺皮质功能，并确定肾上腺功能不全是否导致该高危人群的死亡。
对39例年龄超过50岁因活动性肺结核入院的患者进行肾上腺皮质功能评估。治疗前进行短程促肾上腺皮质激素（Synacthen）刺激试验，并在2个月后重复。对治疗期间死亡的患者进行尸检。特别关注肾上腺的结核累及情况。
治疗前所有患者基础皮质醇浓度均未低于正常。7例（18%）基础皮质醇浓度升高，16例（41%）对Synacthen刺激的皮质醇反应欠佳。14例患者（36%）在治疗期间死亡。与存活者相比，非存活者的基础皮质醇浓度显著更高（743.7±288.5 vs 460.5±123.2 nmol/L，P<0.0001）。对9例治疗期间死亡的患者进行了尸检。仅在1例基础皮质醇浓度高的患者中发现肾上腺结核累及。治疗2个月后，所有患者皮质醇浓度正常，仅4例Synacthen反应略欠佳。与治疗后2个月时相比，就诊时基础皮质醇浓度显著更高（570.4±243.8 vs 386.3±108.3 nmol/L，P = 0.0014）。
肺结核患者肾上腺功能不全并不常见。对Synacthen皮质醇反应欠佳通常反映应激继发的基础状态过度刺激。抗结核药物治疗导致基础皮质醇降低，同时Synacthen反应改善。
