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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...

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Autores principales: Rodríguez-Gutiérrez, René, Rendon, Adrian, Barrera-Sánchez, Maximiliano, Carlos-Reyna, Kevin Erick Gabriel, Álvarez-Villalobos, Neri Alejandro, González-Saldivar, Gloria, González-González, José Gerardo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi Publishing Corporation 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4781954/
https://www.ncbi.nlm.nih.gov/pubmed/27006656
http://dx.doi.org/10.1155/2016/9051865
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author Rodríguez-Gutiérrez, René
Rendon, Adrian
Barrera-Sánchez, Maximiliano
Carlos-Reyna, Kevin Erick Gabriel
Álvarez-Villalobos, Neri Alejandro
González-Saldivar, Gloria
González-González, José Gerardo
author_facet Rodríguez-Gutiérrez, René
Rendon, Adrian
Barrera-Sánchez, Maximiliano
Carlos-Reyna, Kevin Erick Gabriel
Álvarez-Villalobos, Neri Alejandro
González-Saldivar, Gloria
González-González, José Gerardo
author_sort Rodríguez-Gutiérrez, René
collection PubMed
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.
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spelling pubmed-47819542016-03-22 Multidrug-Resistant Tuberculosis and Its Association with Adrenal Insufficiency: Assessment with the Low-Dose ACTH Stimulation Test Rodríguez-Gutiérrez, René Rendon, Adrian Barrera-Sánchez, Maximiliano Carlos-Reyna, Kevin Erick Gabriel Álvarez-Villalobos, Neri Alejandro González-Saldivar, Gloria González-González, José Gerardo Int J Endocrinol Research Article 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. Hindawi Publishing Corporation 2016 2016-02-23 /pmc/articles/PMC4781954/ /pubmed/27006656 http://dx.doi.org/10.1155/2016/9051865 Text en Copyright © 2016 René Rodríguez-Gutiérrez et al. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Rodríguez-Gutiérrez, René
Rendon, Adrian
Barrera-Sánchez, Maximiliano
Carlos-Reyna, Kevin Erick Gabriel
Álvarez-Villalobos, Neri Alejandro
González-Saldivar, Gloria
González-González, José Gerardo
Multidrug-Resistant Tuberculosis and Its Association with Adrenal Insufficiency: Assessment with the Low-Dose ACTH Stimulation Test
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
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4781954/
https://www.ncbi.nlm.nih.gov/pubmed/27006656
http://dx.doi.org/10.1155/2016/9051865
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