Primary Adrenal Insufficiency Contributes to Mortality in Adrenal Tuberculosis

Primary adrenal insufficiency (PAI) is a common manifestation in patients with adrenal tuberculosis (ATB) and contributes to mortality, according to a study published in the Journal of the Endocrine Society. 

Researchers conducted a retrospective, register-based study from January 2005 to December 2019 comparing the prevalence of tuberculosis in patients with adrenal lesions with patients who did not have lesions. The team stratified participants into subgroups consisting of individuals with adrenal tuberculosis (ATB; n=8), patients with nonfunctional adrenal tumors (NFAT; n=23,232), and control group participants without tumors (n=144,124), and compared mortality rates between subgroups. Investigators also noted mortality rates among patients with tuberculosis, both with and without adrenal involvement. 

The investigation identified primary adrenal insufficiency in 88% of individuals with adrenal tuberculosis. A total of 34 patients with NFAT (0.15%) also had a diagnosis of tuberculosis compared with 129 (0.09%) control group participants, revealing an increased risk of tuberculosis in participants with tumors (odds ratio [OR], 1.64; 95% CI, 1,12-2.39; P =.011).

Patients with ATB demonstrated a higher risk of unadjusted mortality with a hazard ratio (HR) of 5.4 (95% CI, 2.2-13.2; P <.001) compared with control group participants with tuberculosis. Individuals with both tuberculosis and NFAT did not have a significantly higher risk of unadjusted mortality (HR, 1.3; 95% CI, 0.6-2.7; P =.51) compared with the control group. After adjusting for age and sex, patients with ATB and participants with both NFAT and tuberculosis had a higher risk of mortality (HR, 6.2; 95% CI, 2.5-15.6; P <.001 and HR, 2.3; 95% CI, 1.1-5.1; P =.032, respectively) compared with the control group participants diagnosed with tuberculosis. Primary adrenal insufficiency was a contributing factor in 67% of deaths in patients with ATB. 

“PAI and adrenal crisis seemed to be important causes of death in those with adrenal tuberculosis,” the study authors explain. “Thus, it seems crucial to evaluate adrenal function in patients with tuberculosis and adrenal lesions in addition to all patients with tuberculosis with symptoms of PAI.”

Study limitations include potential misclassifications in the register-based system and a lack of access to imaging and laboratory findings.