The adrenal gland and the patient with pulmonary tuberculosis infected with human immunodeficiency virus

Odeniyi, I.A; Fasanmade, O.A; Ogbera, Anthonia O; Ohwovoriole, A.E

doi:10.4103/2468-6859.199167

Cited by 5 publications

(4 citation statements)

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“…For more than a century, the adrenal glands have been the most commonly involved endocrine organs in tuberculosis [ 65 ]. Relative to other causes of PAI in Africa, this has been described in greater detail for this continent than for other continents, possibly due to the high tuberculosis burden in Africa [ 66 , 67 ]. The frequency of adrenal insufficiency among patients with pulmonary tuberculosis TB in sub-Saharan Africa is reported to range between 0.9% and 59% [ 68 ], depending on the region where it is endemic.…”

Section: Resultsmentioning

confidence: 99%

Characteristics and Challenges of Primary Adrenal Insufficiency in Africa: A Review of the Literature

Mofokeng

Beshyah

Ross

2022

International Journal of Endocrinology

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Backgrounds. Africa comprises 54 countries with varying degrees of economic development. As with other healthcare systems, rare diseases such as adrenal insufficiency are neglected and poorly documented. Objectives. We wished to explore primary adrenal insufficiency (PAI) in Africa, its prevalence, aetiology, genetics, presentation, diagnosis, and treatment and to determine the unmet needs in clinical care, education, and research. Materials and Methods. A narrative nonsystematic review of the literature was undertaken. We searched two online databases (PubMed and Google scholar) using the search terms “Addison’s disease/PAI, primary adrenal insufficiency coupled with “Africa,” “country names,” and “genetic disorders.” A total of 184 PAI records were reviewed. The exclusion of abstracts, conference proceedings, single case reports, and duplicate studies covering the same subject matter yielded 124 articles, of which 97 informed the final manuscript. Results. A wide range of aetiology of PAI was encountered, but their true prevalence is unknown. Aetiology varied with region and age of presentation as reflected by predominantly TB, HIV, and infective causes occurring in sub-Saharan Africa and more congenital forms described in North Africa associated with consanguinity. In Africa, the diagnostic criteria for PAI do not universally accord with conventional criteria, and there is a heavy reliance on clinical suspicion and biochemistry, including random cortisol of <400 nmol/L, rather than the tetracosactide test where stimulated cortisol <500–550 nmol/L confirms the diagnosis. Conclusions. A high index of suspicion is warranted to diagnose PAI in resource-limited settings, especially where tetracosactide tests are not universally available.

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Section: Resultsmentioning

confidence: 99%

Characteristics and Challenges of Primary Adrenal Insufficiency in Africa: A Review of the Literature

Mofokeng

Beshyah

Ross

2022

International Journal of Endocrinology

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“…Subclinical FAI occurs in 23% of persons with pulmonary TB (PTB) infection [12], and is prevalent among patients with both DS and DR TB [11]. TB and HIV co-infection may compromise adrenocortical function and produce significant adrenocortical insufficiency [13].…”

Section: Introductionmentioning

confidence: 99%

“…Among severely ill HIV-positive adults in Uganda, FAI occurred in 19%, and those receiving rifampicin had 11 times higher odds of FAI [16]. A retrospective analysis of 13,762 patients (13,492 autopsies and 270 adrenalectomies) in Hong Kong found that active TB was present in 871 (6.5%) of 13,492 autopsies performed [17].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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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.

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“…Subclinical FAI occurs in 23% of persons with pulmonary TB (PTB) infection [12], and is prevalent among patients with both DS and DR TB [11]. HIV and TB co-infection may compromise adrenocortical function and produce significant adrenocortical insufficiency [13].Globally, MDR-TB occurred in 3.5% of new and 18% of previously treated cases in 2017 [14]. In Uganda, a high TB-HIV burden country, prevalence of MDR-TB was 1.6% among newly diagnosed patients and 12.0% among previously treated patients [15].…”

Section: Introductionmentioning

confidence: 99%

Functional Adrenal Insufficiency among Tuberculosis-Human Immunodeficiency Virus co-infected patients: A Cross-section study in Uganda

Naggirinya

Mujugira

Meya

et al. 2020

Preprint

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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 prevalence and factors associated with functional adrenal insufficiency (FAI) among human immunodeficiency virus (HIV)-infected patients with drug-resistant and drug-susceptible TB in Uganda. Patients with drug-sensitive and -resistant TB were enrolled, 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 : A total of 311 TB patients were screened, and 272 enrolled. Of these, 117 (43%) had drug-resistant TB. Median age was 32 years (IQR 18-66) and 66% were men. Prevalence of 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 analysis, drug-resistant TB (aOR 4.61; 95% CI: 2.3-9.1; p < 0.001), treatment duration > 1month (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.

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The adrenal gland and the patient with pulmonary tuberculosis infected with human immunodeficiency virus

Cited by 5 publications

References 0 publications

Characteristics and Challenges of Primary Adrenal Insufficiency in Africa: A Review of the Literature

Characteristics and Challenges of Primary Adrenal Insufficiency in Africa: A Review of the Literature

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

Functional Adrenal Insufficiency among Tuberculosis-Human Immunodeficiency Virus co-infected patients: A Cross-section study in Uganda

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