[Cosyntropin test in severe active tuberculosis].
BACKGROUND
Frequency of adrenal insufficiency in patients with tuberculosis varies from 0 to 58%; however, all published series excluded severely ill patients. 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 microg/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 the signs and symptoms improved after antituberculous and hydrocortisone treatment. The 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 supplemental steroid treatment in severe active tuberculosis should be established by a randomized clinical trial.
Casanova-Cardiel
Luis Javier
LJ
Unidad de Cuidados Intensivos y Medicina Crítica, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico, D.F. hinfecto@hotmail.com
Flores-Barrientos
Oscar Israel
OI
Schabib-Hany
Muslim
M
Miranda-Ruiz
Rogelio
R
Castañón-González
Jorge Alberto
JA
D000309:Adrenal Insufficiency / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D000328:Adult; D000995:Antitubercular Agents / Q000627:therapeutic use; D003366:Cosyntropin / Q000008:administration & dosage; D004359:Drug Therapy, Combination; D004977:Ethambutol / Q000008:administration & dosage; D005260:Female; D015658:HIV Infections / Q000150:complications; D006801:Humans; D006854:Hydrocortisone / Q000097:blood* / Q000378:metabolism / Q000627:therapeutic use; D007538:Isoniazid / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011718:Pyrazinamide / Q000008:administration & dosage; D012293:Rifampin / Q000627:therapeutic use; D018805:Sepsis / Q000188:drug therapy / Q000209:etiology / Q000503:physiopathology; D014391:Tuberculosis, Miliary / Q000150:complications / Q000188:drug therapy / Q000503:physiopathology; D014397:Tuberculosis, Pulmonary / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology
D000995:Antitubercular Agents; D003366:Cosyntropin; D011718:Pyrazinamide; D004977:Ethambutol; D007538:Isoniazid; D012293:Rifampin; D006854:Hydrocortisone