Functional Adrenal Insufficiency among Tuberculosis-Human Immunodeficiency Virus co-infected patients: A Cross-section study in Uganda

Abstract Objective:Tuberculosis is the leading cause of adrenal insufficiency in resource-limited settings. The adrenal gland is the most commonly affected endocrine organ in tuberculosis infection. We assessed prevalence and factors associated with functional adrenal insufficiency among human immunodeficiency virus infected patients with multidrug-resistant and drug-susceptible tuberculosis in Uganda. Patients with drug-sensitive and resistant tuberculosis were enrolled, examined for clinical signs and symptoms of adrenal insufficiency, an early morning serum cortisol level obtained. Functional adrenal insufficiency was defined as early morning serum cortisol below 414/nmol//L. Associations with functional adrenal insufficiency were estimated using multivariable logistic regression.ResultsA total of 311 tuberculosis patients were screened, and 272 enrolled. Of these, 117 (43%) had multi-drug resistant tuberculosis. Median age was 32 years (IQR 18-66) and 66% were men. Prevalence of functional adrenal insufficiency was 59.8%. Mean cortisol levels were lower in participants with multi-drug resistant than drug-susceptible tuberculosis (317.4 versus 488.5 nmol/L; p<0.001). In multivariable analysis, multi-drug resistant tuberculosis (aOR 36.60; 95% CI 8.30-161.42; p<0.001) and skin hyperpigmentation (aOR 9.63; 95% CI: 2.83-32.8; p<0.001) were significantly associated with functional adrenal insufficiency. Early morning serum cortisol levels should be quantified in TB-HIV co-infected patients.