The prevalence and factors associated with adrenal insufficiency among patients with sputum smear positive pulmonary tuberculosis admitted to Mulago Hospital.

Abstract

BACKGROUND: Tuberculosis (TB) is still one of the common infections which cause adrenal insufficiency in the developing countries. That is why we set out to determine the prevalence and factors associated with adrenal insufficiency among patients with sputum smear positive pulmonary TB (PTB) admitted to Mulago Hospital. METHODS: After screening 325 pulmonary tuberculosis suspects, 12 years and above admitted on the pulmonology unit of Mulago Hospital, Kampala, Uganda, 200 new patients with sputum smear positive PTB not receiving corticosteroids were enrolled after obtaining informed consent to determine the prevalence and factors associated with adrenal insufficiency. RESULTS: Adrenal insufficiency, was detected in 24 (12%) of the study patients. After controlling for confounding using logistic regression analysis, the factors associated with adrenal insufficiency were; abdominal pain (p=0.01, OR 4.7, 95% CI 1.30-111.85), Salt craving (p=0.028 OR 12.08, 95% CI 12.08, 95% CI 1.30-111.85, Muscle pain (p=0.046, 0R 4.59, 95% CI 1.04-20.59) and nausea (p=0.22, OR 0.24, 95% CI 0.070-0.81). CONCLUSION: One out of every eight patients who participated in this had adrenal insufficiency. This study hence demonstrates that adrenal insufficiency is a common complication of PTB in a Ugandan setting. The factors associated with adrenal insufficiency in this study were, abdominal pain, salt craving, muscle pains and absence of nausea. These factors can be helpful in identifying patients with sputum smear positive PTB at high risk for adrenal insufficiency. These are the patients to be prioritized for adrenal function assessment using the low doze ACTH stimulation test in our resource limited setting.