Functional adrenal insufficiency among tuberculosis-human immunodeficiency virus co-infected patients: A cross-sectional study in Uganda

Agnes Bwanika Naggirinya, Andrew Mujugira, David B. Meya, Irene Andia Biraro, Ezekiel Mupere, William Worodria, Yukari C. Manabe

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: Tuberculosis (TB) is the leading cause of adrenal insufficiency in resource-limited settings. The adrenal gland is the most commonly affected endocrine organ in TB infection. We assessed factors associated with functional adrenal insufficiency (FAI) among TB-HIV patients with and without drug-resistance in Uganda. Patients with drug-sensitive and drug-resistant TB were enrolled and examined for clinical signs and symptoms of FAI with an early morning serum cortisol level obtained. FAI was defined as early morning serum cortisol < 414 nmol//L. Associations with FAI were modeled using multivariable logistic regression. Results: We screened 311 TB patients and enrolled 272. Of these, 117 (43%) had drug-resistant TB. Median age was 32 years (IQR 18-66) and 66% were men. The proportion with FAI was 59.8%. Mean cortisol levels were lower in participants with drug-resistant than susceptible TB (317.4 versus 488.5 nmol/L; p < 0.001). In multivariable analyses, drug-resistant TB (aOR 4.61; 95% CI 2.3-9.1; p < 0.001), treatment duration > 1 month (aOR 2.86; 95% CI 1.4-5.5; p = 0.002) and abdominal pain (aOR 2.06; 95% CI 1.04-4.09; p = 0.038) were significantly associated with FAI. Early morning serum cortisol levels should be quantified in TB-HIV co-infected patients with drug-resistant TB.

Original languageEnglish (US)
Article number224
JournalBMC Research Notes
Volume13
Issue number1
DOIs
StatePublished - Apr 19 2020

Keywords

  • Adrenal
  • Africa
  • HIV
  • Insufficiency
  • TB

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)

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