Multidrug-Resistant Tuberculosis and Its Association with Adrenal Insufficiency: Assessment with the Low-Dose ACTH Stimulation Test
Background. Multidrug-resistant tuberculosis (MDR-TB) is a major public health care concern that affects the life of millions of people around the world. The association of tuberculosis and adrenal insufficiency is well known; however, it is thought to be less prevalent every time. A spike in TB inc...
Saved in:
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2016-01-01
|
| Series: | International Journal of Endocrinology |
| Online Access: | http://dx.doi.org/10.1155/2016/9051865 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1832551420118695936 |
|---|---|
| author | René Rodríguez-Gutiérrez Adrian Rendon Maximiliano Barrera-Sánchez Kevin Erick Gabriel Carlos-Reyna Neri Alejandro Álvarez-Villalobos Gloria González-Saldivar José Gerardo González-González |
| author_facet | René Rodríguez-Gutiérrez Adrian Rendon Maximiliano Barrera-Sánchez Kevin Erick Gabriel Carlos-Reyna Neri Alejandro Álvarez-Villalobos Gloria González-Saldivar José Gerardo González-González |
| author_sort | René Rodríguez-Gutiérrez |
| collection | DOAJ |
| description | Background. Multidrug-resistant tuberculosis (MDR-TB) is a major public health care concern that affects the life of millions of people around the world. The association of tuberculosis and adrenal insufficiency is well known; however, it is thought to be less prevalent every time. A spike in TB incidence and a lack of evidence of this association in patients with MDR-TB call for reassessment of an illness (adrenal dysfunction) that if not diagnosed could seriously jeopardize patients’ health. Objective. To determine the prevalence of adrenocortical insufficiency in patients with MDR-TB using the low-dose (1 μg) ACTH stimulation test at baseline and at 6–12 months of follow-up after antituberculosis treatment and culture conversion. Methods. A total of 48 men or women, aged ≥18 years (HIV-negative patients diagnosed with pulmonary MDR-TB) were included in this prospective observational study. Blood samples for serum cortisol were taken at baseline and 30 and 60 minutes after 1 μg ACTH stimulation at our tertiary level university hospital before and after antituberculosis treatment. Results. Forty-seven percent of subjects had primary MDR-TB; 43.8% had type 2 diabetes; none were HIV-positive. We found at enrollment 2 cases (4.2%) of adrenal insufficiency taking 500 nmol/L as the standard cutoff point value and 4 cases (8.3%) alternatively, using 550 nmol/L. After antituberculosis intensive phase drug-treatment and a negative mycobacterial culture (10.2±3.6 months) adrenocortical function was restored in all cases. Conclusions. In patients with MDR-TB, using the low-dose ACTH stimulation test, a low prevalence of mild adrenal insufficiency was observed. After antituberculosis treatment adrenal function was restored in all cases. Given the increasing and worrying epidemic of MDR-TB these findings have important clinical implications that may help clinicians and patients make better decisions when deciding to test for adrenocortical dysfunction or treat insufficient stimulated cortisol levels in the setting of MDR-TB. |
| format | Article |
| id | doaj-art-b1ea9b8a4b4945e0b66cf367cdf54fe1 |
| institution | Kabale University |
| issn | 1687-8337 1687-8345 |
| language | English |
| publishDate | 2016-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | International Journal of Endocrinology |
| spelling | doaj-art-b1ea9b8a4b4945e0b66cf367cdf54fe12025-02-03T06:01:35ZengWileyInternational Journal of Endocrinology1687-83371687-83452016-01-01201610.1155/2016/90518659051865Multidrug-Resistant Tuberculosis and Its Association with Adrenal Insufficiency: Assessment with the Low-Dose ACTH Stimulation TestRené Rodríguez-Gutiérrez0Adrian Rendon1Maximiliano Barrera-Sánchez2Kevin Erick Gabriel Carlos-Reyna3Neri Alejandro Álvarez-Villalobos4Gloria González-Saldivar5José Gerardo González-González6Endocrinology Division, University Hospital “Dr. Jose E. Gonzalez”, Medical School, Autonomous University of Nuevo Leon, 64460 Monterrey, NL, MexicoDepartment of Internal Medicine, University Hospital “Dr. Jose E. Gonzalez”, Medical School, Autonomous University of Nuevo Leon, 64460 Monterrey, NL, MexicoDepartment of Internal Medicine, University Hospital “Dr. Jose E. Gonzalez”, Medical School, Autonomous University of Nuevo Leon, 64460 Monterrey, NL, MexicoDepartment of Internal Medicine, University Hospital “Dr. Jose E. Gonzalez”, Medical School, Autonomous University of Nuevo Leon, 64460 Monterrey, NL, MexicoClinical Research Unit, Medical School, Autonomous University of Nuevo Leon, 64460 Monterrey, NL, MexicoDepartment of Internal Medicine, University Hospital “Dr. Jose E. Gonzalez”, Medical School, Autonomous University of Nuevo Leon, 64460 Monterrey, NL, MexicoEndocrinology Division, University Hospital “Dr. Jose E. Gonzalez”, Medical School, Autonomous University of Nuevo Leon, 64460 Monterrey, NL, MexicoBackground. Multidrug-resistant tuberculosis (MDR-TB) is a major public health care concern that affects the life of millions of people around the world. The association of tuberculosis and adrenal insufficiency is well known; however, it is thought to be less prevalent every time. A spike in TB incidence and a lack of evidence of this association in patients with MDR-TB call for reassessment of an illness (adrenal dysfunction) that if not diagnosed could seriously jeopardize patients’ health. Objective. To determine the prevalence of adrenocortical insufficiency in patients with MDR-TB using the low-dose (1 μg) ACTH stimulation test at baseline and at 6–12 months of follow-up after antituberculosis treatment and culture conversion. Methods. A total of 48 men or women, aged ≥18 years (HIV-negative patients diagnosed with pulmonary MDR-TB) were included in this prospective observational study. Blood samples for serum cortisol were taken at baseline and 30 and 60 minutes after 1 μg ACTH stimulation at our tertiary level university hospital before and after antituberculosis treatment. Results. Forty-seven percent of subjects had primary MDR-TB; 43.8% had type 2 diabetes; none were HIV-positive. We found at enrollment 2 cases (4.2%) of adrenal insufficiency taking 500 nmol/L as the standard cutoff point value and 4 cases (8.3%) alternatively, using 550 nmol/L. After antituberculosis intensive phase drug-treatment and a negative mycobacterial culture (10.2±3.6 months) adrenocortical function was restored in all cases. Conclusions. In patients with MDR-TB, using the low-dose ACTH stimulation test, a low prevalence of mild adrenal insufficiency was observed. After antituberculosis treatment adrenal function was restored in all cases. Given the increasing and worrying epidemic of MDR-TB these findings have important clinical implications that may help clinicians and patients make better decisions when deciding to test for adrenocortical dysfunction or treat insufficient stimulated cortisol levels in the setting of MDR-TB.http://dx.doi.org/10.1155/2016/9051865 |
| spellingShingle | René Rodríguez-Gutiérrez Adrian Rendon Maximiliano Barrera-Sánchez Kevin Erick Gabriel Carlos-Reyna Neri Alejandro Álvarez-Villalobos Gloria González-Saldivar José Gerardo González-González Multidrug-Resistant Tuberculosis and Its Association with Adrenal Insufficiency: Assessment with the Low-Dose ACTH Stimulation Test International Journal of Endocrinology |
| title | Multidrug-Resistant Tuberculosis and Its Association with Adrenal Insufficiency: Assessment with the Low-Dose ACTH Stimulation Test |
| title_full | Multidrug-Resistant Tuberculosis and Its Association with Adrenal Insufficiency: Assessment with the Low-Dose ACTH Stimulation Test |
| title_fullStr | Multidrug-Resistant Tuberculosis and Its Association with Adrenal Insufficiency: Assessment with the Low-Dose ACTH Stimulation Test |
| title_full_unstemmed | Multidrug-Resistant Tuberculosis and Its Association with Adrenal Insufficiency: Assessment with the Low-Dose ACTH Stimulation Test |
| title_short | Multidrug-Resistant Tuberculosis and Its Association with Adrenal Insufficiency: Assessment with the Low-Dose ACTH Stimulation Test |
| title_sort | multidrug resistant tuberculosis and its association with adrenal insufficiency assessment with the low dose acth stimulation test |
| url | http://dx.doi.org/10.1155/2016/9051865 |
| work_keys_str_mv | AT renerodriguezgutierrez multidrugresistanttuberculosisanditsassociationwithadrenalinsufficiencyassessmentwiththelowdoseacthstimulationtest AT adrianrendon multidrugresistanttuberculosisanditsassociationwithadrenalinsufficiencyassessmentwiththelowdoseacthstimulationtest AT maximilianobarrerasanchez multidrugresistanttuberculosisanditsassociationwithadrenalinsufficiencyassessmentwiththelowdoseacthstimulationtest AT kevinerickgabrielcarlosreyna multidrugresistanttuberculosisanditsassociationwithadrenalinsufficiencyassessmentwiththelowdoseacthstimulationtest AT nerialejandroalvarezvillalobos multidrugresistanttuberculosisanditsassociationwithadrenalinsufficiencyassessmentwiththelowdoseacthstimulationtest AT gloriagonzalezsaldivar multidrugresistanttuberculosisanditsassociationwithadrenalinsufficiencyassessmentwiththelowdoseacthstimulationtest AT josegerardogonzalezgonzalez multidrugresistanttuberculosisanditsassociationwithadrenalinsufficiencyassessmentwiththelowdoseacthstimulationtest |