title: Hypoadrenalism is not associated with early mortality during tuberculosis treatment in Malawi.
abstract: METHODS
  In the developing world, early mortality within 1 month of commencing tuberculosis (TB) treatment is high, particularly with human immunodeficiency virus (HIV) co-infection. In Malawi, 40% of those who die do so in the first month of treatment. Reasons remain unclear and may include delayed diagnosis, opportunistic infections, immune restoration inflammatory syndrome (IRIS) or malnutrition. One possible contributing factor is underlying hypoadrenalism associated with TB-HIV, exacerbated by rifampicin (RMP) induction of P450 and glucocorticoid metabolism.
  
  
  OBJECTIVE
  To assess the prevalence of hypoadrenalism in TB patients before and after commencement of TB treatment, and relationship with early mortality.
  
  
  METHODS
  Prospective descriptive study assessing hypoadrenalism before and after anti-tuberculosis treatment, HIV status and outcome up to 3 months post-treatment.
  
  
  RESULTS
  Of 51 patients enrolled, 29 (56.9%) were female (median age 32 years, range 18-62). Of 43 patients HIV-tested, 38 (88.3%) were HIV-positive and 15.7% died within the first month. At 3 months, 11 (21.6%) were known to have died. Adequate cortisol levels were found in 49/51 (95.9%) before commencing RMP. Neither of the two with reduced response died. All 34 patients revealed adequate cortisol responses at 2 weeks.
  
  
  CONCLUSIONS
  No evidence of hypoadrenalism was found in this first study to assess adrenal function and outcome of anti-tuberculosis treatment.
authors.affiliation: Department of Medicine, College of Medicine, University of Malawi, Blantyre, Malawi. mikebeadsworth@yahoo.com
authors.forename: M B J
authors.initials: MB
authors.lastname: Beadsworth
authors.forename: J J
authors.initials: JJ
authors.lastname: van Oosterhout
authors.forename: M J
authors.initials: MJ
authors.lastname: Diver
authors.forename: E B
authors.initials: EB
authors.lastname: Faragher
authors.forename: A
authors.initials: A
authors.lastname: Shenkin
authors.forename: H C
authors.initials: HC
authors.lastname: Mwandumba
authors.forename: S
authors.initials: S
authors.lastname: Khoo
authors.forename: T
authors.initials: T
authors.lastname: O'Dempsey
authors.forename: S B
authors.initials: SB
authors.lastname: Squire
authors.forename: E E
authors.initials: EE
authors.lastname: Zijlstra
mesh_terms: D000293:Adolescent; D000309:Adrenal Insufficiency / Q000097:blood / Q000453:epidemiology*; D000328:Adult; D000904:Antibiotics, Antitubercular / Q000009:adverse effects / Q000627:therapeutic use*; D015897:Comorbidity; D005260:Female; D015658:HIV Infections / Q000453:epidemiology*; D006801:Humans; D006854:Hydrocortisone / Q000097:blood; D008295:Malawi / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012293:Rifampin / Q000009:adverse effects / Q000627:therapeutic use*; D014397:Tuberculosis, Pulmonary / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality
chemical_list: D000904:Antibiotics, Antitubercular; D012293:Rifampin; D006854:Hydrocortisone