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

Abstract Objective : Tuberculosis (TB) is the leading cause of adrenal insufficiency in resource-limited settings. The adrenal gland is the most commonly affected endocrine organ in TB infection. We assessed factors associated with functional adrenal insufficiency (FAI) among TB-HIV patients with and without drug-resistance in Uganda. Patients with drug-sensitive and drug-resistant TB were enrolled and examined for clinical signs and symptoms of FAI with an early morning serum cortisol level obtained. FAI was defined as early morning serum cortisol <414 nmol//L. Associations with FAI were modeled using multivariable logistic regression. Results : We screened 311 TB patients and enrolled 272. Of these, 117 (43%) had drug-resistant TB. Median age was 32 years (IQR 18-66) and 66% were men. The proportion with FAI was 59.8%. Mean cortisol levels were lower in participants with drug-resistant than susceptible TB (317.4 versus 488.5 nmol/L; p<0.001 ) . In multivariable analyses, drug-resistant TB (aOR 4.61; 95% CI: 2.3-9.1; p < 0.001), treatment duration > 1 month (aOR 2.86; 95% CI: 1.4-5.5; p=0.002) and abdominal pain (aOR 2.06; 95% CI: 1.04-4.09; p=0.038) were significantly associated with FAI. Early morning serum cortisol levels should be quantified in TB-HIV co-infected patients with drug-resistant TB.