Prevalence of Adrenal Insufficiency and Adrenal Morphology in Treatment-Naïve Tuberculosis Patients: A Cross-Sectional Study From a High-Burden Region

IF 2.4 3区医学 Q2 ENDOCRINOLOGY & METABOLISM

Clinical Endocrinology Pub Date : 2025-06-02 DOI:10.1111/cen.15282

Ajeesh Thulaseedharan, Puthiyaveettil Khadar Jabbar, Sanjeev Nair, Chellamma Jayakumari, Sree Priya Pankajakshan Rema, Darvin Vamadevan Das, Ramesh Gomez, Sankar Sethuraman, Soumya Sarayu, Abilash Nair

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引用次数: 0

Abstract

Background and Objectives

Adrenal insufficiency (AI) is a recognized complication in tuberculosis (TB), with previous studies reporting a highly variable prevalence (0%–76%), primarily during or after antitubercular treatment (ATT). However, data on AI prevalence in treatment-naïve TB patients remains scarce. This study aimed to determine the prevalence of AI and adrenal gland morphology in adult patients with newly diagnosed, treatment-naïve TB.

Materials and Methods

This cross-sectional study included 100 treatment-naïve adult TB patients attending the Revised National Tuberculosis Control Program (RNTCP) clinic at Government Medical College Hospital, Thiruvananthapuram, and Chest Disease Hospital, Pulayanarkotta. Patients with HIV, uncontrolled diabetes, critical illness, or recent steroid use were excluded. Due to the COVID-19 pandemic, patient attendance was limited. Clinical features suggestive of AI were assessed based on symptoms and laboratory findings, including hyponatremia and hyperkalemia. An ACTH stimulation test was performed using 0.5 mL (30 units) of long-acting porcine ACTH (Acton Prolongatum) intramuscularly. Serum cortisol levels were measured at 60 and 120 min after administration. AI was defined as a peak cortisol level below 17 μg/dL at 60 min and below 19.5 μg/dL at 120 min. Contrast-enhanced CT (CECT) Abdomen or Thorax images were analyzed for adrenal morphology in one AI-diagnosed TB patient and a subset of 14 TB patients without AI, and 18 age-matched healthy controls without TB or chronic lung pathology.

Results

Among 100 patients (88% pulmonary TB [PTB], 12% extrapulmonary TB[EPTB]) with a mean age of 50 ± 15.4 years and a male-to-female ratio of 3.1:1, 27 patients (27%) exhibited clinical features suggestive of AI. The mean peak serum cortisol levels were 35.17 ± 10.77 μg/dL at 60 min and 39.67 ± 10.84 μg/dL at 120 min. AI was diagnosed in one patient with EPTB (1%), while none of the patients with PTB had AI. CT analysis revealed significantly reduced right adrenal Hounsfield unit (HU) density (p = 0.02) and lateral limb thickness (p = 0.01) in TB patients versus controls, despite absent adrenal enlargement.

Conclusion

AI is rare (1%) in treatment-naïve TB patients despite the overlapping clinical features in a significant proportion. Subtle adrenal morphological changes without enlargement suggest early TB-related alterations without overt dysfunction. Future research should prioritize larger TB cohorts including Extrapulmonary TB to enhance detection of adrenal pathology while minimizing radiation exposure with detailed immune assessments.

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Treatment-Naïve结核病患者肾上腺功能不全和肾上腺形态的患病率：来自高负担地区的横断面研究。

背景和目的：肾上腺功能不全（AI）是结核病（TB）公认的并发症，先前的研究报告了高度可变的患病率（0%-76%），主要是在抗结核治疗（ATT）期间或之后。然而，关于treatment-naïve结核病患者中AI流行率的数据仍然很少。本研究旨在确定AI和肾上腺形态在新诊断的成人患者treatment-naïve TB中的患病率。材料和方法：本横断面研究包括100名treatment-naïve成年结核病患者，他们在Thiruvananthapuram政府医学院医院和Pulayanarkotta胸病医院的修订国家结核病控制计划（RNTCP）诊所就诊。排除了患有HIV、未控制的糖尿病、危重疾病或近期使用类固醇的患者。由于COVID-19大流行，患者就诊有限。根据症状和实验室结果评估提示AI的临床特征，包括低钠血症和高钾血症。采用0.5 mL（30个单位）长效猪ACTH （Acton Prolongatum）肌注进行促ACTH刺激试验。在给药后60和120分钟测定血清皮质醇水平。AI定义为60 min时皮质醇峰值低于17 μg/dL， 120 min时低于19.5 μg/dL。对比增强CT （CECT）腹部或胸部图像分析了一名AI诊断的结核病患者和14名未诊断AI的结核病患者，以及18名年龄匹配的无结核病或慢性肺部病理的健康对照者的肾上腺形态。结果：100例患者中（肺结核[PTB]占88%，肺外肺结核[EPTB]占12%），平均年龄为50±15.4岁，男女比例为3.1:1,27例（27%）表现出提示AI的临床特征。60 min时血清皮质醇平均峰值为35.17±10.77 μg/dL， 120 min时平均峰值为39.67±10.84 μg/dL。一名EPTB患者（1%）被诊断出AI，而所有PTB患者均无AI。CT分析显示，尽管没有肾上腺肿大，但结核患者的右肾上腺Hounsfield单位（HU）密度（p = 0.02）和侧肢厚度（p = 0.01）明显低于对照组。结论：AI在treatment-naïve结核患者中罕见（1%），但临床特征重叠的比例显著。细微的肾上腺形态改变未增大提示早期结核相关改变，无明显功能障碍。未来的研究应优先考虑包括肺外结核在内的更大的结核病队列，以加强肾上腺病理的检测，同时通过详细的免疫评估最大限度地减少辐射暴露。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Endocrinology 医学-内分泌学与代谢

CiteScore

6.40

自引率

3.10%

发文量

192

审稿时长

1 months

期刊介绍： Clinical Endocrinology publishes papers and reviews which focus on the clinical aspects of endocrinology, including the clinical application of molecular endocrinology. It does not publish papers relating directly to diabetes care and clinical management. It features reviews, original papers, commentaries, correspondence and Clinical Questions. Clinical Endocrinology is essential reading not only for those engaged in endocrinological research but also for those involved primarily in clinical practice.