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International Journal of Endocrinology
Volume 2016, Article ID 9051865, 7 pages
http://dx.doi.org/10.1155/2016/9051865
Research Article

Multidrug-Resistant Tuberculosis and Its Association with Adrenal Insufficiency: Assessment with the Low-Dose ACTH Stimulation Test

1Endocrinology Division, University Hospital “Dr. Jose E. Gonzalez”, Medical School, Autonomous University of Nuevo Leon, 64460 Monterrey, NL, Mexico
2Department of Internal Medicine, University Hospital “Dr. Jose E. Gonzalez”, Medical School, Autonomous University of Nuevo Leon, 64460 Monterrey, NL, Mexico
3Knowledge and Evaluation Research Unit in Endocrinology, Mayo Clinic, Rochester, MN 55905, USA
4Division of Endocrinology, Diabetes, Metabolism & Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
5Centro de Investigacion, Prevencion y Tratamiento de Infecciones Respiratorias (CIPTIR), Autonomous University of Nuevo Leon, 64460 Monterrey, NL, Mexico
6Clinical Research Unit, Medical School, Autonomous University of Nuevo Leon, 64460 Monterrey, NL, Mexico

Received 4 December 2015; Revised 14 January 2016; Accepted 26 January 2016

Academic Editor: Andrea G. Lania

Copyright © 2016 René Rodríguez-Gutiérrez et al. 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.

Abstract

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 ( 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.