cosyntropin and Tuberculosis--Pulmonary

Tuberculosis is a major public health problem in Pakistan and adrenal involvement in long-standing tuberculosis has been found to be common. A multi-center study was conducted to assess the adrenal function using short Synacthen test in one hundred patients with tuberculosis of more than 6 months duration at three hospitals of Rawalpindi and Islamabad. Forty patients demonstrated impaired response to Synacthen test. In 21 (52.5%) the increment from basal level was less than 300 nmol/L with a peak level increasing to over 600 mmol/L in 15 (37.5%) patients, the increment from basal level was less than 300 nmol/L as well as the peak level was also less than 600 nmol/L. In 4 (10%) patients the increment was more than 300 nmol/L but they were not able to obtain a peak level of 600 nmol/L. No significant difference was found between the patients with normal response and the impaired response with regards to their clinical features, duration of illness, body mass index (BMI), blood pressure variation and routine biochemical profile. It is concluded that adrenal dysfunction is common in patients with long-standing tuberculosis. Diagnosis of hypoadrenalism is not possible on clinical grounds and routine biochemical examinations. Synacthen stimulation test is necessary for its diagnosis.

Topics: Adrenal Cortex Diseases; Adrenal Cortex Function Tests; Adrenal Glands; Adult; Chronic Disease; Cosyntropin; Female; Humans; Male; Middle Aged; Sensitivity and Specificity; Tuberculosis, Pulmonary

Tuberculosis of the adrenal glands may cause overt or subclinical adrenal insufficiency. An algorithm-based approach including assessment of paired basal cortisol and plasma adrenocorticotropic hormone (ACTH), short Synacthen, and plasma renin activity assays could be useful to diagnose all forms of adrenal insufficiency.. This cross-sectional study included consecutive, treatment-naive subjects diagnosed with pulmonary tuberculosis. Tuberculosis severity was classified by radiological criteria. Baseline parameters plus morning (8 am) serum cortisol and paired plasma ACTH were measured in all patients. Synacthen stimulation tests and plasma renin activity assays were performed as required.. Eighty-four treatment-naive consecutive cases of pulmonary tuberculosis were evaluated for adrenal insufficiency. Twenty-seven (32.14%) subjects had normal adrenocortical function and 8 (9.5%), 7 (8.3%), 40 (47.6%), and 2 (2.4%) subjects had stage 1, stage 2, stage 3, and stage 4 adrenal insufficiency, respectively. Serum cortisol was negatively correlated with radiological severity (P = .01) and duration of illness (P = .001). Adrenal dysfunction was present in 27.3%, 82.5%, and 80% of those with radiologically minimal, moderately advanced, and far-advanced disease, respectively. Mean cortisol was 19.74 ± 5.52, 17.42 ± 8.53, and 15.71 ± 7.14 (μg/dL) in the 3 groups, respectively (P = .042). Hyponatremia was present in 83.3% of the patients. Serum sodium was negatively correlated with severity but not with the duration of disease.. The prevalence of overt and subclinical adrenal dysfunction in pulmonary tuberculosis was high and was correlated with disease severity and duration. An algorithmic approach may be useful to detect the same and may have important clinical implications.

Topics: Adrenal Insufficiency; Adrenocorticotropic Hormone; Cosyntropin; Cross-Sectional Studies; Humans; Hydrocortisone; Tuberculosis, Pulmonary

The adrenal glands may be involved in tuberculosis. The exact frequency and extent of adrenal involvement in tuberculosis are not well known. Although there are some studies regarding adrenal gland involvement, they are not sufficient because of inadequate endocrinological tests and radiological procedures. The aim of this study was to assess the adrenal gland in acute and chronic pulmonary tuberculosis and to compare it with the findings obtained in healthy subjects.. We studied 20 patients with acute pulmonary tuberculosis, 41 patients with chronic pulmonary tuberculosis and 20 healthy subjects. Involvement of the adrenal gland was assessed by basal cortisol level, cortisol response to Synacthen and adrenal computed tomography.. Cortisol levels were measured before, 30 and 60 minutes after Synacthen (250 micrograms i.v.) injection. Computerized tomography of the adrenals was carried out in 61 patients with tuberculosis and 20 healthy subjects.. Mean basal cortisol level and 60-minute cortisol response to Synacthen were significantly higher in acute pulmonary tuberculosis than in chronic pulmonary tuberculosis and healthy subjects. Two patients with Addison's disease were diagnosed among the chronic tuberculous patients. Both length and thickness of the right and left adrenal gland were greater in patients with acute tuberculosis.. Adrenal enlargement demonstrated by computerized tomography is common in patients with acute pulmonary tuberculosis, but our findings show that cortisol reserve is normal, in contrast to previous suggestions.

Topics: Acute Disease; Adolescent; Adrenal Glands; Adult; Aged; Chronic Disease; Cosyntropin; Female; Humans; Hydrocortisone; Male; Middle Aged; Prospective Studies; Tomography, X-Ray Computed; Tuberculosis, Pulmonary

A regional hospital in Hong Kong.. To evaluate adrenocortical function in older patients admitted to hospital with active pulmonary tuberculosis (TB) and to determine whether adrenal insufficiency contributes to mortality in this high risk group.. Adrenocortical function was assessed in 39 consecutive patients aged over 50 admitted to hospital with active pulmonary TB. Short Synacthen stimulation tests were performed before treatment and repeated at 2 months. In patients who died during treatment, a post-mortem examination was performed. Particular attention was paid to TB involvement of the adrenal glands.. None of the patients had a subnormal basal cortisol concentration before treatment. 7 (18%) had raised basal cortisol concentrations and 16 (41%) had suboptimal cortisol responses to Synacthen stimulation. 14 patients (36%) died during treatment. The basal cortisol concentrations were significantly higher in the non-survivors compared to the survivors (743.7 +/- 288.5 vs 460.5 +/- 123.2 nmol/L, P < 0.0001). Autopsies were performed in 9 patients who died during treatment. Tuberculous involvement of the adrenal glands was found in only 1 patient who had a high basal cortisol concentration. After 2 months of treatment, all patients had normal cortisol concentrations and only 4 had borderline suboptimal Synacthen responses. The basal cortisol concentrations were significantly higher at presentation compared to those at 2 months after treatment (570.4 +/- 243.8 vs 386.3 +/- 108.3 nmol/L, P = 0.0014).. Adrenal insufficiency is uncommon in patients with pulmonary TB. Suboptimal cortisol responses to Synacthen usually reflect a hyperstimulated basal state secondary to stress. Treatment with anti-TB drugs causes reduction in basal cortisol with associated improvement in the Synacthen response.

Topics: Adrenal Cortex; Aged; Aged, 80 and over; Antitubercular Agents; Cosyntropin; Female; Humans; Hydrocortisone; Male; Middle Aged; Prospective Studies; Retrospective Studies; Tuberculosis, Pulmonary

Adrenocortical function was studied in patients with pulmonary tuberculosis and the findings compared with those in healthy subjects. Plasma cortisol levels in newly diagnosed patients were appreciably higher than in the healthy subjects (P less than 0.001). A normal (positive) response to ACTH (tetracosactrin) stimulation was observed in 35 (97%) of 36 healthy subjects, 15 (56%) of 27 newly diagnosed patients with tuberculosis and 5 (42%) of 12 chronic cases (i.e. those who had had the disease for more than 3 years); the difference between the healthy subjects and the two groups of tuberculosis patients was highly significant (P less than 0.001). Dexamethasone caused an appreciable decrease in the plasma cortisol levels of tuberculosis patients. Considering the diurnal variation of cortisol secretion, there was a steady decline in the cortisol levels between 08:00 and 20:00 in the healthy subjects (P = 0.02); in the tuberculosis patients, however, there was a decrease up to 16:00 followed by a significant increase (P = 0.05), and the mean value at 20:00 was similar to that at 08:00.

Topics: Adrenal Cortex; Adult; Chronic Disease; Circadian Rhythm; Cosyntropin; Dexamethasone; Humans; Hydrocortisone; Middle Aged; Reproducibility of Results; Tuberculosis, Pulmonary

Eighteen patients with recently diagnosed pulmonary tuberculosis were studied for factors which could predict, at the outset, reactions to treatment. Abnormally low corticosteroid responses to tetracosactrin were seen in some but not all of the patients who deteriorated while on treatment. Those who deteriorated transiently or died had pre-treatment C-reactive protein (CRP) concentrations above 20 mg/l, which then persisted. As previously observed, those who responded unfavourably were older, had extensive disease and presented with hypoalbuminaemia and hyponatraemia.

Topics: Adrenal Cortex Hormones; Adult; Aged; Aged, 80 and over; C-Reactive Protein; Cosyntropin; Female; Forecasting; Humans; Hydrocortisone; Male; Middle Aged; Tuberculosis, Pulmonary

The difficulties of long term treatment of chronic obstructive lung disease demand knowledge and use of every reasonable therapeutic regimen. In this study effectivity and side effects of Depot-ACTH (Tetracosactid) are presented. The main indications for the use of Depot-ACTH seem to be the uneffectiveness of usual therapy and the attempt of avoiding or reducing corticosteroids. The study confirms the excellent usefulness of Depot-ACTH which did not diminish during long-term application. The side effects are rare and mostly inferior. Only allergic reactions may be serious and must be accounted for.

Topics: Adolescent; Adrenocorticotropic Hormone; Adult; Aged; Asthma; Child; Cosyntropin; Diabetes Complications; Drug Hypersensitivity; Edema; Female; Humans; Lung Diseases, Obstructive; Male; Middle Aged; Pregnancy; Pregnancy Complications; Pulmonary Emphysema; Tuberculosis, Pulmonary