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Multidrug-Resistant Tuberculosis and Its Association with Adrenal Insufficiency: Assessment with the Low-Dose ACTH Stimulation Test
Joint Authors
González-Saldivar, Gloria
Alvarez-Villalobos, Neri Alejandro
González-González, Jose Gerardo
Rendon, Adrian
Barrera-Sánchez, Maximiliano
Carlos-Reyna, Kevin Erick Gabriel
Rodríguez-Gutiérrez, René
Source
International Journal of Endocrinology
Issue
Vol. 2016, Issue 2016 (31 Dec. 2016), pp.1-7, 7 p.
Publisher
Hindawi Publishing Corporation
Publication Date
2016-02-23
Country of Publication
Egypt
No. of Pages
7
Main Subjects
Abstract EN
Background.
Multidrug-resistant tuberculosis (MDR-TB) is a major public health care concern that affects the life of millions of people around the world.
The association of tuberculosis and adrenal insufficiency is well known; however, it is thought to be less prevalent every time.
A spike in TB incidence and a lack of evidence of this association in patients with MDR-TB call for reassessment of an illness (adrenal dysfunction) that if not diagnosed could seriously jeopardize patients’ health.
Objective.
To determine the prevalence of adrenocortical insufficiency in patients with MDR-TB using the low-dose (1 μg) ACTH stimulation test at baseline and at 6–12 months of follow-up after antituberculosis treatment and culture conversion.
Methods.
A total of 48 men or women, aged ≥18 years (HIV-negative patients diagnosed with pulmonary MDR-TB) were included in this prospective observational study.
Blood samples for serum cortisol were taken at baseline and 30 and 60 minutes after 1 μg ACTH stimulation at our tertiary level university hospital before and after antituberculosis treatment.
Results.
Forty-seven percent of subjects had primary MDR-TB; 43.8% had type 2 diabetes; none were HIV-positive.
We found at enrollment 2 cases (4.2%) of adrenal insufficiency taking 500 nmol/L as the standard cutoff point value and 4 cases (8.3%) alternatively, using 550 nmol/L.
After antituberculosis intensive phase drug-treatment and a negative mycobacterial culture (10.2±3.6 months) adrenocortical function was restored in all cases.
Conclusions.
In patients with MDR-TB, using the low-dose ACTH stimulation test, a low prevalence of mild adrenal insufficiency was observed.
After antituberculosis treatment adrenal function was restored in all cases.
Given the increasing and worrying epidemic of MDR-TB these findings have important clinical implications that may help clinicians and patients make better decisions when deciding to test for adrenocortical dysfunction or treat insufficient stimulated cortisol levels in the setting of MDR-TB.
American Psychological Association (APA)
Rodríguez-Gutiérrez, René& Rendon, Adrian& Barrera-Sánchez, Maximiliano& Carlos-Reyna, Kevin Erick Gabriel& Alvarez-Villalobos, Neri Alejandro& González-Saldivar, Gloria…[et al.]. 2016. Multidrug-Resistant Tuberculosis and Its Association with Adrenal Insufficiency: Assessment with the Low-Dose ACTH Stimulation Test. International Journal of Endocrinology،Vol. 2016, no. 2016, pp.1-7.
https://search.emarefa.net/detail/BIM-1106043
Modern Language Association (MLA)
Rodríguez-Gutiérrez, René…[et al.]. Multidrug-Resistant Tuberculosis and Its Association with Adrenal Insufficiency: Assessment with the Low-Dose ACTH Stimulation Test. International Journal of Endocrinology No. 2016 (2016), pp.1-7.
https://search.emarefa.net/detail/BIM-1106043
American Medical Association (AMA)
Rodríguez-Gutiérrez, René& Rendon, Adrian& Barrera-Sánchez, Maximiliano& Carlos-Reyna, Kevin Erick Gabriel& Alvarez-Villalobos, Neri Alejandro& González-Saldivar, Gloria…[et al.]. Multidrug-Resistant Tuberculosis and Its Association with Adrenal Insufficiency: Assessment with the Low-Dose ACTH Stimulation Test. International Journal of Endocrinology. 2016. Vol. 2016, no. 2016, pp.1-7.
https://search.emarefa.net/detail/BIM-1106043
Data Type
Journal Articles
Language
English
Notes
Includes bibliographical references
Record ID
BIM-1106043