THE SPECTRUM OF ENDOCRINE DYSFUNCTION IN ACTIVE PULMONARY TUBERCULOSIS

OBJECTIVE Substantial variation in the prevalence (0-55%) of hypoadren alism in tuberculosis (TB) has been reported. The aim of this study wa s to prospectively evaluate adrenal, thyroid and gonadal function in p atients presenting with active pulmonary TB. DESIGN A prospective stud y of 50 patients admitted to a single hospital. PATIENTS Fifty hospita lized adults with newly diagnosed sputum positive pulmonary TB (mean a ge 38 years, mean body mass index 18 kg/m(2), mean albumin 28 g/l) wer e studied. MEASUREMENTS Adrenal reserve was assessed by intravenous te tracosactrin administration with measurement of basal and stimulated c ortisol concentrations. Basal ACTH, thyroid and gonadal hormones were also measured. RESULTS The mean basal serum cortisol was 625 nmol/l (r ange 394-1185). Basal plasma ACTH was undetectable (< 4.4 pmol/l) in 3 2, normal in 17 (mean 11.45, range 4.4-24.9 pmol/l) and elevated in on e (54.2 pmol/l) subjects and did not correlate with cortisol. The mean increment in cortisol following tetracosactrin was 256 nmol/l (range 0-650) and was unrelated to basal cortisol or ACTH. All 50 patients ha d a stimulated plasma cortisol exceeding 550 nmol/l, indicating intact adrenal reserve. Ninety-two per cent of patients had the sick euthyro id syndrome, 72% of males had hypogonadotrophic hypogonadism and 4% of patients tested positive for the human immunodeficiency virus. CONCLU SIONS Hypoadrenalism is uncommon in active pulmonary TB despite freque nt dysfunction of the thyroid and gonadal axes.