Adrenocortical insufficiency in smear positive pulmonary tuberculosis.

We studied 40 patients with pulmonary tuberculosis. All were positive for acid-fast bacilli (AFB) in the sputum. Their mean age was 30 yrs (range 10-50 yrs) and the duration of illness was 26.3 +/- 2.3 months. Radiologically minimal, moderately advanced and far advanced lesions were present in 7 (17.5%), 9 (22.5%) and 23 (57.5%) patients respectively. One patient with endobronchial lesion had no radiological evidence of pulmonary tuberculosis. Clinically, 14 patients (35%) had one or the other features of adrenocortical insufficiency. Postural hypotension was the commonest feature and was present in 11 patients (27.5%), followed by nausea and vomiting (20%), loss of axillary hair and libido (10%), skin and mucosal pigmentation in 7.5% of the cases. ACTH stimulation revealed incomplete adrenocortical insufficiency (partially responsive adrenal) in 5 patients (12.5%) and complete adrenocortical insufficiency (non-responsive adrenal) in 2 patients (5%). Patients with features of adrenal insufficiency had significantly longer duration of illness (p < 0.001) but there was no correlation with extent or type of lesion.