Functional adrenal insufficiency among tuberculosis-human immunodeficiency virus co-infected patients: a cross-sectional study in Uganda

Abstract

Objective: Tuberculosis (TB) is the leading cause of adrenal insufficiency in resource-limited settings. The adrenal gland is the most commonly affected endocrine organ in TB infection. We assessed factors associated with functional adrenal insufficiency (FAI) among TB-HIV patients with and without drug-resistance in Uganda. Patients with drugsensitive and drug-resistant TB were enrolled and examined for clinical signs and symptoms of FAI with an early morning serum cortisol level obtained. FAI was defined as early morning serum cortisol < 414 nmol//L. Associations with FAI were modeled using multivariable logistic regression. Results:We screened 311 TB patients and enrolled 272. Of these, 117 (43%) had drug-resistant TB. Median age was 32 years (IQR 18-66) and 66% were men. The proportion with FAI was 59.8%. Mean cortisol levels were lower in participants with drug-resistant than susceptible TB (317.4 versus 488.5 nmol/L; p < 0.001). In multivariable analyses, drugresistant TB (aOR 4.61; 95% CI 2.3-9.1; p < 0.001), treatment duration > 1 month (aOR 2.86; 95% CI 1.4-5.5; p = 0.002) and abdominal pain (aOR 2.06; 95% CI 1.04-4.09; p = 0.038) were significantly associated with FAI. Early morning serum cortisol levels should be quantified in TB-HIV co-infected patients with drug-resistant TB.

Morphometric analysis of adrenal gland in people living with human immunodeficiency virus

“…Functional adrenal insufficiency, subnormal corticosteroid production during acute illness, results in high morbidity and mortality in critically ill patients. Functional adrenal insufficiency is common among people living with HIV, with incidence rates up to 75% 5 . However, studies examining effect of the HIV infection to the adrenal gland morphometry are limited in the literature.…”

“…The peritoneal reflection along the lateral aspect of the inferior vena cava is divided and the AG is than mobilized laterally exposing the suprarenal vein, which often emerges from the posterior aspect of the vena cava inferior. Therefore, the evaluation of the distance of the AG to the near anatomical structures is important for the surgical approach [2][3][4][5] . So, we evaluated in our study distances between AG and esophagus, columnar vertebral is, vena cava inferior, aorta abdominal is, diaphragm on the right and left sides.…”