Tuberculous Addison's disease: lack of normalization of adrenocortical function after anti-tuberculous chemotherapy.

OBJECTIVE Tuberculosis of the adrenal glands is a common cause of Addison's disease in developing countries. We conducted a study to determine if treatment of such patients with modern anti-tuberculous chemotherapy would lead to an improvement in plasma cortisol and aldosterone levels. DESIGN Prospective study. PATIENTS 5 patients with Addison's disease secondary to tuberculosis. MEASUREMENTS Basal and ACTH stimulated plasma cortisol and aldosterone levels were measured prior to instituting anti-tuberculous chemotherapy, as well as one month after its conclusion. Four patients were again studied over the next 2–5 years. RESULTS Peak plasma cortisol levels prior to treatment were markedly reduced (range, < 14–110 nmol/l). There was no improvement one month (< 14–143 nmol/l) or 2–5 years (< 14–69 nmol/l) after completing anti-tuberculous chemotherapy. Peak plasma aldosterone at diagnosis was < 56–210 pmol/l; it was undetectable in 4 patients. No improvement was observed one month (< 56–210 pmol/l), or 2–5 years (< 56–389 pmol/l) after stopping anti-tuberculous chemotherapy. Plasma aldosterone levels at both these time points were far lower than those in control subjects (median 763 pmol/l, 560–1512 pmol/l; p < 0.01). One patient had an increase in peak aldosterone from < 56 pmol/l to 389 pmol/l, though peak cortisol actually declined in this subject (from 110 nmol/l to 69 nmol/l). CONCLUSIONS Treatment of tuberculous Addison's disease with anti-tuberculous chemotherapy does not lead to normalization of ACTH stimulated plasma cortisol or aldosterone levels during the 2–5 year period of study. However, prolonged follow up with regular adrenal function tests is warranted in all such patients.