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2008, Number 4

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Cir Cir 2008; 76 (4)

Cosyntropin test in severe active tuberculosis

Casanova-Cardiel LJ, Flores-Barrientos OI, Schabib-Hany M, Miranda-Ruiz R, Castañón-González JA

Language: Spanish
References: 29
Page: 305-309
PDF size: 57.15 Kb.


ABSTRACT

Background: Frequency of adrenal insufficiency in patients with tuberculosis varies from 0 to 58%. Our objective was to investigate adrenal insufficiency with the low-dose cosyntropin test in patients with severe active tuberculosis.
Methods: From two large university affiliated hospitals, 18 patients with tuberculosis and criteria of sepsis or severe sepsis according to SCCM/ACCP criteria, defined by the present authors as severe active tuberculosis, participated in the study. A low-dose ACTH test with 10 mg of ACTH was performed. After ACTH test, all patients received a stress dose of hydrocortisone (240 mg/day) during their entire hospitalization along with four antituberculous drugs. Abnormal response was considered when elevation of serum cortisol was ‹7 µg/dl with respect to basal level, 60 min after ACTH administration.
Results: Adrenal insufficiency was found in seven patients (39%); no clinical or laboratory data were associated with the presence of abnormal adrenal response. Except in one patient with HIV infection, all signs and symptoms improved after antituberculous and hydrocortisone treatment. Increment in serum cortisol value post-ACTH test was lower in patients with hypoalbuminemia.
Conclusions: Adrenal insufficiency is frequent in severe active tuberculosis. The efficacy and security of steroid supplemental treatment in severe active tuberculosis should be established by a randomized clinical trial.


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