@article {Beadsworth:2008:1027-3719:314,
title = "Hypoadrenalism is not associated with early mortality during tuberculosis treatment in Malawi",
journal = "The International Journal of Tuberculosis and Lung Disease",
parent_itemid = "infobike://iuatld/ijtld",
publishercode ="iuatld",
year = "2008",
volume = "12",
number = "3",
publication date ="2008-03-01T00:00:00",
pages = "314-318",
itemtype = "ARTICLE",
issn = "1027-3719",
eissn = "1815-7920",
url = "https://www.ingentaconnect.com/content/iuatld/ijtld/2008/00000012/00000003/art00016",
keyword = "tuberculosis, sub-Saharan Africa, Malawi, hypoadrenalism, HIV",
author = "Beadsworth, M. B. J. and van Oosterhout, J. J. and Diver, M. J. and Faragher, E. B. and Shenkin, A. and Mwandumba, H. C. and Khoo, S. and O'Dempsey, T. and Squire, S. B. and Zijlstra, E. E.",
abstract = "SETTING: In the developing world, early mortality within 1 month of commencing tuberculosis (TB) treatment is high, particularly with human immunodeficiency virus (HIV) co-infection. In Malawi, 40% of those who die do so in the first month of treatment. Reasons remain unclear and may include delayed diagnosis, opportunistic infections, immune restoration inflammatory syndrome (IRIS) or malnutrition. One possible contributing factor is underlying hypoadrenalism associated with TB-HIV, exacerbated by rifampicin (RMP) induction of P450 and glucocorticoid metabolism.OBJECTIVE: To assess the prevalence of hypoadrenalism in TB patients before and after commencement of TB treatment, and relationship with early mortality.DESIGN: Prospective descriptive study assessing hypoadrenalism before and after anti-tuberculosis treatment, HIV status and outcome up to 3 months post-treatment.RESULTS: Of 51 patients enrolled, 29 (56.9%) were female (median age 32 years, range 1862). Of 43 patients HIV-tested, 38 (88.3%) were HIV-positive and 15.7% died within the first month. At 3 months, 11 (21.6%) were known to have died. Adequate cortisol levels were found in 49/51 (95.9%) before commencing RMP. Neither of the two with reduced response died. All 34 patients revealed adequate cortisol responses at 2 weeks.CONCLUSION: No evidence of hypoadrenalism was found in this first study to assess adrenal function and outcome of anti-tuberculosis treatment.",
}