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  • Title: A Study of Adrenocortical Function in Patients with Pulmonary Tuberculosis and its Response to Anti Tubercular Therapy(ATT).
    Author: K B.
    Journal: J Assoc Physicians India; 2022 Apr; 70(4):11-12. PubMed ID: 35443503.
    Abstract:
    UNLABELLED: Tuberculosis may lead to adrenal insufficiency by direct glandular involvement, by extra glandular infection or as a by-product of Anti tuberculous therapy. Subclinical adrenal insufficiency becomes important in stressful situation which require increased release of ACTH to meet heightened metabolic demands. Our objective was to determine the adrenal reserve in patients with pulmonary tuberculosis and to determine the effect of ATT on adrenal function. MATERIAL: Prospective observational study was performed on 50 pulmonary tuberculosis patients. Blood sample for baseline serum cortisol is drawn between 8:00 and 8:30 a.m. with patients fasting overnight. Patients with serum cortisol level < 220 nmol/L will be followed up by ACTH stimulation by injecting 250μg of Cosyntropin intramuscularly and blood samples for serum cortisol is drawn at 30 and 60 minutes. Serum cortisol levels < 220 nmol/L, Post-ACTH <500 nmol/L or post ACTH increment <200 nmol/L are suggestive of adrenal insufficiency. After ATT patients are followed up and tests are repeated. OBSERVATION: The mean age group in my study is 47.1+ 11.6 with majority being male. The mean cortisol both basal and post intravenous ACTH was significantly lower in cases before ATT compared to after ATT (mean + SD basal cortisol of 367.38+164.08mmol/l before ATT vs 535.32 + 156.39 mmol/l after ATT). and post ACTH, cortisol at 30 min is 319.78 + 85.6mmol/l before ATT vs 342.5 +73.6 mmol/l after and cortisol at 60 min is 333.6429 +98.17 mmol/l before ATT vs 351 +70.8 mmol/l after ATT with the p value of 0.0092). CONCLUSION: TB associated endocrinopathies are not infrequent. Clinically overt manifestations of these conditions are however unusual. Incidence of adrenal insufficiency in pulmonary tuberculosis patients was high, and it was confirmed with ACTH stimulation test. This present study helps identifying cases at risk of fatal adrenal crisis and institute timely management, thus improving disease prognosis.
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