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Adrenal function during tuberculous infection and effects of antituberculosis treatment on endogenous and exogenous steroids

Authors: Keven, K.1; Uysal, A. R.2; Erdogan, G.3

Source: The International Journal of Tuberculosis and Lung Disease, Volume 2, Number 5, May 1998 , pp. 419-424(6)

Publisher: International Union Against Tuberculosis and Lung Disease

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Abstract:

Setting: 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.

Objective: 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.

Design: 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 dexamethaxone suppression test before and during antituberculosis treatment.

Results and Conclusion: 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 dexamethosone 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.

Keywords: adrenal function; antituberculosis treatment; steroid metabolism; tuberculosis

Document Type: Regular Paper

Affiliations: 1: Department of Geriatric Medicine, Ankara University Medical School, Ankara, Turkey 2: Department of Endocrinology, Ankara University Medical School, Ankara, Turkey 3: Department of Metabolic Diseases, Ankara University Medical School, Ankara, Turkey

Publication date: May 1, 1998

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  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on tuberculosis and lung health world-wide.

    Certain IJTLD articles are selected for translation into French, Spanish, Chinese or Russian. They are available on the Union website

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