Department of Infectious Disease
Mycobacteriology Rsearch Center
Department of Pulmonary Medicine
Tobacco Prevention and Control Research Center
Lung Transplantation Research Center
Department of Pediatrics, NRITLD, Shaheed Beheshti University of Medical Sciences and Health Services, TEHRAN-IRAN.
Background: Adrenal insufficiency following initial treatment of active tuberculosis (TB) is a rare phenomenon. It is also one of the most important causes of mortality within the first few days of TB treatment. The present study evaluated this adverse effect of anti-tuberculous treatment. Materials and Methods: A prospective study was performed on TB patients hospitalized in Masih Daneshvari Hospital between 2004 and 2005. All patients had received standard anti-TB drug regimen. We evaluated pseudo-adrenal insufficiency in these patients. Results: The study group included 429 patients out of which 6(1.4%) developed adrenal insufficiency following anti-TB treatment. In all 6 patients, basal serum cortisol levels were measured which were below the normal range after treatment. No patient had clinical findings of adrenal insufficiency before initiation of anti-TB therapy. After treatment with dexamethasone, the general condition of patients improved. (The average response to treatment was 3.1±1.7 days). No mortality was reported during the treatment course or follow-up period. Conclusion: In TB patients, the adrenal reserve/ serum cortisol reserve level is low. Standard anti-TB drug regimen including rifampicin causes rapid catabolism of cortisol in tissues specially in the liver and lungs; therefore, serum cortisol level will be more decreased and consequently the patient develops adrenal insufficiency. As a whole, despite of the low incidence rate of this adverse effect, early diagnosis and treatment is essential to save the patient's life. (Tanaffos 2007; 6(1): 67-70)