Adrenocortical function in Nigerian patients with pulmonary tuberculosis (PTB)

Area of Science:

• Endocrinology
• Infectious Diseases
• Pulmonology

Background:

• Tuberculosis (TB) can affect adrenal glands, potentially leading to Addison's disease.
• Pulmonary Tuberculosis (PTB) is prevalent in Nigeria, yet adrenal cortex function in these patients remains understudied.
• Subclinical adrenocortical failure in PTB patients is a critical consideration, as cortisol deficiency may cause sudden death.

Purpose of the Study:

• To determine the prevalence of subclinical adrenocortical failure in Nigerian PTB patients.
• To assess adrenal cortex function using a low-dose ACTH stimulation test in PTB patients.

Main Methods:

• A low-dose (1 µg) ACTH stimulation test was administered to 44 newly diagnosed, treatment-naive PTB patients and 70 healthy controls.
• Basal cortisol levels and cortisol response at 30 minutes post-ACTH stimulation were measured.
• Statistical analysis compared results between PTB patients and healthy subjects.

Main Results:

• No significant difference in basal cortisol levels was observed between PTB patients and healthy controls (229.1 vs. 239.9 nmol/L).
• The 30-minute cortisol response and increment following ACTH stimulation were significantly lower in PTB patients compared to controls.
• Approximately 23% of PTB patients exhibited signs of subclinical adrenocortical insufficiency.

Conclusions:

• Subclinical adrenocortical insufficiency is common in Nigerian PTB patients.
• Basal cortisol levels are insufficient for diagnosing adrenocortical insufficiency in PTB.
• ACTH stimulation tests are essential for accurate diagnosis and management of suspected adrenocortical insufficiency in PTB patients.