Hypoadrenalism in patients with pulmonary tuberculosis in Tanzania: an undiagnosed complication?

Addison's disease is rarely diagnosed in most African countries although tuberculosis, one of its major causes, is a widespread problem. In this study adrenal function was assessed using the Synacthen test in 50 patients with chronic pulmonary tuberculosis admitted to hospital in Dar es Salaam. Sixteen patients (32%) had an impaired response. Two had subnormal basal cortisol levels, one of whom had a normal response to Synacthen. There was no significant difference between the patients with an impaired cortisol response and those with a normal response with respect to frequency of non-specific symptoms, weight loss and body mass index. The mean supine and erect diastolic blood pressures were, however, significantly lower in those with an impaired cortisol response compared to the normal cortisol response group (64 mm Hg vs 74 mm Hg supine (P less than 0.01), and 62 mm Hg vs 73 mm Hg erect (P less than 0.005]. Basal and one-hour plasma cortisol levels correlated significantly with systolic and diastolic blood pressure, and correlated negatively with duration of tuberculosis and diastolic blood pressure. These findings are consistent with reported observations in Zulu patients with pulmonary tuberculosis, and suggest that impaired adrenal function may contribute to morbidity and even mortality among patients with tuberculosis in Africa. Adrenal hypofunction should be considered in any tuberculosis patient with hypotension and poor response to chemotherapy.