Keven K, Uysal A R, Erdogan G
Department of Geriatric Medicine, Ankara University Medical School, Turkey.
Int J Tuberc Lung Dis. 1998 May;2(5):419-24.
To date, few studies have been published on the frequency of adrenal disorder during active tuberculosis and whether rifampicin treatment has an adverse effect on adrenal function.
We evaluated endogenous and exogenous steroid metabolism in patients with active tuberculosis before and during treatment to observe whether the functions were affected by tuberculosis and rifampicin.
Basal hormone levels and Synacthen stimulation test were obtained in 22 patients with active tuberculosis before and 20-30 days after antituberculosis treatment including rifampicin. Exogenous steroid metabolism was assessed by 1 mg overnight dexamethasone suppression test before and during antituberculosis treatment.
No significant differences were found on basal plasma cortisol or adrenocorticotropic hormone levels, but significant decrements were found on basal dehydroepiandrosterone sulfate (P < 0.05) and urinary free cortisol levels (P < 0.01) before and after commencing antituberculosis treatment. After Synacthen stimulation, only one patient had insufficient increment in plasma cortisol levels. This patient was diagnosed as a case of Addison's disease. Although nine patients (42%) showed sufficient suppression of cortisol secretion on the dexamethasone test before treatment, none had sufficient suppression with dexamethasone after antituberculosis treatment. We found less mean maximum adrenal cortisol responsiveness to Synacthen stimulation during the course of antituberculosis treatment (P < 0.01). Although impairment of adrenal function is a rare condition in active tuberculosis, rifampicin may have a significant effect on steroid metabolism.
迄今为止，关于活动性结核病期间肾上腺疾病的发生率以及利福平治疗是否对肾上腺功能有不良影响的研究报道较少。
我们评估了活动性结核病患者在治疗前及治疗期间内源性和外源性类固醇代谢情况，以观察其功能是否受到结核病和利福平的影响。
对22例活动性结核病患者在抗结核治疗（包括利福平）前及治疗后20 - 30天测定基础激素水平并进行促肾上腺皮质激素（Synacthen）刺激试验。在抗结核治疗前及治疗期间通过1毫克过夜地塞米松抑制试验评估外源性类固醇代谢。
基础血浆皮质醇或促肾上腺皮质激素水平未发现显著差异，但开始抗结核治疗前后基础硫酸脱氢表雄酮水平（P < 0.05）和尿游离皮质醇水平（P < 0.01）有显著下降。Synacthen刺激后，只有1例患者血浆皮质醇水平升高不足，该患者被诊断为艾迪生病。尽管9例患者（42%）在治疗前的地塞米松试验中显示皮质醇分泌充分受抑制，但抗结核治疗后用地塞米松时均无充分抑制。我们发现在抗结核治疗过程中，肾上腺对Synacthen刺激的平均最大皮质醇反应性降低（P < 0.01）。虽然肾上腺功能损害在活动性结核病中是一种罕见情况，但利福平可能对类固醇代谢有显著影响。
