PMID- 18284838
OWN - NLM
STAT- MEDLINE
DCOM- 20080529
LR  - 20131121
IS  - 1027-3719 (Print)
IS  - 1027-3719 (Linking)
VI  - 12
IP  - 3
DP  - 2008 Mar
TI  - Hypoadrenalism is not associated with early mortality during tuberculosis 
      treatment in Malawi.
PG  - 314-8
AB  - SETTING: 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. DESIGN: 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. 
      CONCLUSION: No evidence of hypoadrenalism was found in this first study to assess 
      adrenal function and outcome of anti-tuberculosis treatment.
FAU - Beadsworth, M B J
AU  - Beadsworth MB
AD  - Department of Medicine, College of Medicine, University of Malawi, Blantyre, 
      Malawi. mikebeadsworth@yahoo.com
FAU - van Oosterhout, J J
AU  - van Oosterhout JJ
FAU - Diver, M J
AU  - Diver MJ
FAU - Faragher, E B
AU  - Faragher EB
FAU - Shenkin, A
AU  - Shenkin A
FAU - Mwandumba, H C
AU  - Mwandumba HC
FAU - Khoo, S
AU  - Khoo S
FAU - O'Dempsey, T
AU  - O'Dempsey T
FAU - Squire, S B
AU  - Squire SB
FAU - Zijlstra, E E
AU  - Zijlstra EE
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - France
TA  - Int J Tuberc Lung Dis
JT  - The international journal of tuberculosis and lung disease : the official journal 
      of the International Union against Tuberculosis and Lung Disease
JID - 9706389
RN  - 0 (Antibiotics, Antitubercular)
RN  - VJT6J7R4TR (Rifampin)
RN  - WI4X0X7BPJ (Hydrocortisone)
SB  - IM
MH  - Adolescent
MH  - Adrenal Insufficiency/blood/*epidemiology
MH  - Adult
MH  - Antibiotics, Antitubercular/adverse effects/*therapeutic use
MH  - Comorbidity
MH  - Female
MH  - HIV Infections/*epidemiology
MH  - Humans
MH  - Hydrocortisone/blood
MH  - Malawi/epidemiology
MH  - Male
MH  - Middle Aged
MH  - Prevalence
MH  - Prospective Studies
MH  - Rifampin/adverse effects/*therapeutic use
MH  - Tuberculosis, Pulmonary/drug therapy/*epidemiology/mortality
EDAT- 2008/02/21 09:00
MHDA- 2008/05/30 09:00
CRDT- 2008/02/21 09:00
PHST- 2008/02/21 09:00 [pubmed]
PHST- 2008/05/30 09:00 [medline]
PHST- 2008/02/21 09:00 [entrez]
PST - ppublish
SO  - Int J Tuberc Lung Dis. 2008 Mar;12(3):314-8.