title: Adrenocortical reserve in patients with active tuberculosis.
abstract: BACKGROUND
  In recent years several studies have documented decreased adrenal cortical reserve in patients with active tuberculosis. This reduced adrenal reserve could be an important factor in causing mortality and morbidity in these patients.
  
  
  OBJECTIVE
  To study the adrenal cortical reserve and its relationship with disease duration and severity in patients with active tuberculosis.
  
  
  METHODS
  Forty patients with confirmed active tuberculosis (28 pulmonary and 12 extra-pulmonary) without clinical evidence of Addison's disease and 10 healthy, age and sex-matched subjects (controls) participated in this study. The study was conducted at Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir.
  
  
  METHODS
  Adrenocorticotropic hormone stimulation test performed in both groups.
  
  
  METHODS
  Basal serum cortisol level and parameters of stimulated cortisol response (maximum increase of cortisol over basal, peak rise of cortisol and area under response curve).
  
  
  RESULTS
  The mean basal cortisol levels were comparable between the two groups (P = 0.792). The parameters of stimulated cortisol response including maximum increase of cortisol over basal, the peak rise of cortisol and area under response curves were significantly lower in patients as compared to healthy controls (P < 0.001, 0.002 and 0.049 respectively). However, these parameters were comparable between patients with active pulmonary and extra-pulmonary tuberculosis. Overall 14 (35%) patients exhibited sub-optimal cortisol response (3 negligible and 11 inadequate) to ACTH stimulation. ACTH stimulation revealed significant cortisol rise in patients with active tuberculosis at 4 and 8 hours only, whereas in healthy controls, the cortisol rise was more prolonged and continued up to 24 hours. The adrenocortical reserve was inversely related to the radiological severity of pulmonary tuberculosis (r, -0.41) and chronicity of active tuberculosis (r, -0.59).
  
  
  CONCLUSIONS
  Patients with active tuberculosis have decreased adrenocortical reserve. The adrenocortical reserve seems to be inversely related to the radiological severity of pulmonary tuberculosis and chronicity of active tuberculosis.
authors.affiliation: Department of Endocrinology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir, India.
authors.forename: A H
authors.initials: AH
authors.lastname: Zargar
authors.forename: F A
authors.initials: FA
authors.lastname: Sofi
authors.forename: M A
authors.initials: MA
authors.lastname: Akhtar
authors.forename: M
authors.initials: M
authors.lastname: Salahuddin
authors.forename: S R
authors.initials: SR
authors.lastname: Masoodi
authors.forename: B A
authors.initials: BA
authors.lastname: Laway
mesh_terms: D000302:Adrenal Cortex / Q000503:physiopathology*; D000328:Adult; D000704:Analysis of Variance; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000097:blood*; D008297:Male; D014376:Tuberculosis / Q000503:physiopathology*; D014397:Tuberculosis, Pulmonary / Q000503:physiopathology
chemical_list: D006854:Hydrocortisone