A hormonal and radiological evaluation of adrenal gland in patients with acute or chronic pulmonary tuberculosis

Keleştimur, Fahrettin; Ünlü, Yalçin; Ozesmi, M; Tolu, İsmet

doi:10.1111/j.1365-2265.1994.tb03784.x

Cited by 39 publications

(31 citation statements)

References 16 publications

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“…We did not find adrenocortical insufficiency in these patients, in contrast to previous suggestions [5]. Post et al also reported intact adrenal reserve in active pulmonary tuberculosis [9].…”

Section: Discussioncontrasting

confidence: 56%

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Changes in the Size of Adrenal Glands in Acute Pulmonary Tuberculosis with Therapy.

et al. 1996

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Abstract. Adrenal glands may be involved during both acute and chronic tuberculosis.They are enlarged in acute pulmonary tuberculosis. We aimed to investigate the changes in adrenal size in acute pulmonary tuberculosis before and after therapy in a prospective study. Eleven hospitalized patients with newly diagnosed sputum positive pulmonary tuberculosis were studied. Basal cortisol levels were measured in the patients before and after the therapy. Cortisol levels were also measured 30 and 60 min after Synacthen (250 µg iv.) injection in the patients before the therapy. The size of the adrenal glands was measured by computerized tomography. The maximum width perpendicular to the long axis of the body of the gland, maximum width of the medial and lateral limbs and the length of the adrenals were measured. All measurements were done before and after the eight-month anti-tuberculosis therapy. All 11 patients had an intact adrenal cortisol reserve. Both the width and length of the right and left adrenal glands were significantly greater before the therapy than after the therapy. We conclude that adrenal enlargement demonstrated by computerized tomography in acute pulmonary tuberculosis is reduced after appropriate therapy.

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Section: Discussioncontrasting

confidence: 56%

“…We have recently demonstrated that the adrenal glands are enlarged and cortisol reserve is normal in patients with acute pulmonary tuberculosis [5]. We think that adrenal enlargement during acute pulmonary tuberculosis is due to a stressful condition caused by acute tuberculosis.…”

Section: Tuberculosismentioning

confidence: 99%

Changes in the Size of Adrenal Glands in Acute Pulmonary Tuberculosis with Therapy.

et al. 1996

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“…Since the increment of cortisol was found to be inversely correlated with basal serum cortisol levels, the increment of cortisol was assumed to be inappropriate for the prediction of adrenal sufficiency [19]. When adrenal glands are maximally stimulated by endogenous ACTH in stressful conditions such as tuberculosis, serum cortisol levels will be high and therefore exogenous ACTH may fail to further stimulate the adrenal glands [20]. We did not find any correlation between basal cortisol and D cortisol during standard dose ACTH stimulation test, but weak negative correlations were found between basal cortisol and D cortisol of low dose ACTH and glucagon stimulation tests.…”

Section: Discussionmentioning

confidence: 99%

The comparison of low and standard dose ACTH and glucagon stimulation tests in the evaluation of hypothalamo-pituitary-adrenal axis in healthy adults

et al. 2010

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Evaluation of the HPA axis is still a challenge; due to different sensitivities and stimulation efficiencies of dynamic tests, lack of standard assays for cortisol measurement and lack of data regarding the effects of age and gender on the results of the HPA axis evaluation with different dynamic tests. This study was performed to compare 1 μg ACTH, 250 μg ACTH and glucagon tests in the evaluation of HPA axis. The study was carried out on 55 healthy individuals (28 men, 27 women). 10-12 volunteers were included from every decades between 20 and 70 years. Low dose short synacthen test (1 μg ACTH), standard dose short synacthen test (250 μg ACTH) and glucagon tests were performed consecutively. The mean peak cortisol response to standard dose ACTH stimulation test was found to be significantly higher than the low dose ACTH and glucagon stimulation tests. The mean peak cortisol responses to low dose ACTH and the glucagon stimulation tests were not significantly different. The mean peak cortisol responses did not differ significantly between different age or sex groups. The lowest peak cortisol responses obtained after low dose ACTH and glucagon stimulation tests were 12.5 and 9.1 μg/dl respectively in the volunteers who all had cortisol responses higher than 20 μg/dl after standard dose ACTH stimulation test. The lowest cortisol responses obtained during 250 μg ACTH, 1 μg ACTH and glucagon stimulation tests were found to be 20.1, 12.5 and 9.1 μg/dl in a known group of healthy people. So the consideration of appropriate hormonal cut-off levels for each test seems reasonable. The age, sex and body mass indeces were not shown to affect the cortisol response to dynamic stimulation tests.

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“…Tuberculosis is still one of the most important infectious agents that causes adrenal involvement [27]. Kelestimur et al [29] and Gulmez et al [28] found that adrenal glands were enlarged during acute pulmonary tuberculosis, followed by a later decrease in the size of the adrenals at the end of the therapy, and they reported that adrenocorticoid function is increased.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, numerous studies have now shown increased serum cortisol levels in HIV-infected patients [22,23]. The adrenal glands may be involved and enlarged by granulomatous infections (such as tuberculosis, histoplasmosis and blastomycosis), HIV and related infections [24][25][26][27][28][29]. Tuberculosis is still one of the most important infectious agents that causes adrenal involvement [27].…”

Section: Discussionmentioning

confidence: 99%

Investigation of the Hypothalamo-pituitary-adrenal Axis and Changes in the Size of Adrenal Glands in Acute Brucellosis

et al. 2005

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Abstract. The aim of the study was to investigate the hypothalamo-pituitary-adrenal (HPA) axis by ACTH stimulation test and the changes in adrenal size in acute brucellosis before and after therapy in a prospective study. Sixteen patients with acute brucellosis and 15 healthy subjects were included in the study during the last two years. Cortisol levels were assessed before, 30 and 60 minutes after ACTH (250 mg i.v.) injection and the size of the adrenals was measured in both groups. Mean basal cortisol levels in the patients before the therapy and after the therapy were 22.1 ± 6.9 mg/dL and 11.3 ± 6.0 mg/dL, respectively. The difference was statistically significant (p<0.001). There was also statistically significant difference for basal cortisol levels between the healthy subjects (12.2 ± 4.6 mg/dL) and the patients before the therapy (p<0.001). Peak cortisol responses to ACTH were higher before the therapy in the patients with acute brucellosis (39.3 ± 10.7 mg/dL) than in the healthy subjects (30.4 ± 4.8 mg/dL, p = 0.014). However, there was no significant difference for peak cortisol levels in the patients before and after the therapy (32.7 ± 8.0 mg/dL). Mean basal cortisol levels and peak cortisol responses to ACTH between the patients after the therapy and the healthy controls were similar. Both the maximum width of the adrenal glands and the width of the adrenal limbs were significantly greater before the therapy compared to healthy subjects and post-treatment period. We concluded that the HPA axis is activated and the adrenal glands are enlarged in acute brucellosis, which is reduced after appropriate therapy.

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A hormonal and radiological evaluation of adrenal gland in patients with acute or chronic pulmonary tuberculosis

Abstract: Adrenal enlargement demonstrated by computerized tomography is common in patients with acute pulmonary tuberculosis, but our findings show that cortisol reserve is normal, in contrast to previous suggestions.

Cited by 39 publications

References 16 publications

Changes in the Size of Adrenal Glands in Acute Pulmonary Tuberculosis with Therapy.

Changes in the Size of Adrenal Glands in Acute Pulmonary Tuberculosis with Therapy.

The comparison of low and standard dose ACTH and glucagon stimulation tests in the evaluation of hypothalamo-pituitary-adrenal axis in healthy adults

Investigation of the Hypothalamo-pituitary-adrenal Axis and Changes in the Size of Adrenal Glands in Acute Brucellosis

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