A HORMONAL AND RADIOLOGICAL EVALUATION OF ADRENAL-GLAND IN PATIENTS WITH ACUTE OR CHRONIC PULMONARY TUBERCULOSIS

OBJECTIVE The adrenal glands may be involved in tuberculosis. The exac t frequency and extent of adrenal involvement in tuberculosis are not well known. Although there are some studies regarding adrenal gland in volvement, they are not sufficient because of inadequate endocrinologi cal tests and radiological procedures. The aim of this study was to as sess the adrenal gland in acute and chronic pulmonary tuberculosis and to compare it with the findings obtained in healthy subjects. DESIGN AND PATIENTS We studied 20 patients with acute pulmonary tuberculosis, 41 patients with chronic pulmonary tuberculosis and 20 healthy subjec ts. Involvement of the adrenal gland was assessed by basal cortisol le vel, cortisol response to Synacthen and adrenal computed tomography. M EASUREMENTS Cortisol levels were measured before, 30 and 60 minutes af ter Synacthen (250 mu g i.v.) injection. Computerized tomography of th e adrenals was carried out in 61 patients with tuberculosis and 20 hea lthy subjects. RESULTS Mean basal cortisol level and 60-minute cortiso l response to Synacthen were significantly higher in acute pulmonary t uberculosis than in chronic pulmonary tuberculosis and healthy subject s. Two patients with Addison's disease were diagnosed among the chroni c tuberculous patients. Both length and thickness of the right and lef t adrenal gland were greater in patients with acutetuberculosis. CONCL USION Adrenal enlargement demonstrated by computerized tomography is c ommon in patients with acute pulmonary tuberculosis, but our findings show that cortisol reserve is normal, in contrast to previous suggesti ons.