Low dose (1 μg) adrenocorticotropin stimulation test in the evaluation of hypothalamopituitary-adrenal axis in patients with active pulmonary tuberculosis

Adrenocortical function in patients with active pulmonary tuberculosis is a debate of matter. Previous studies related to adrenocortical function in patients with active pulmonary tuberculosis demonstrated a high rate of suboptimal cortisol response to standard dose ACTH (250 mu g) stimulation test. The aim of this study was to assess the hypothalamo-pituitary-adrenal (HPA) axis in low dose (1 mu g) and standard dose ACTH (250 mu g) stimulation tests in the patients with active pulmonary tuberculosis. Twenty-seven patients and 21 healthy subjects were included in the study. Cortisol levels were measured before, 30 and 60 min after ACTH (1 (mu g or 250 mu g iv) injection. Cortisol responses to 1 mu g ACTH at 30 and 60 min were significantly higher in the patient group than in the control group (p0.05). This study shows that 1 mu g ACTH iv gives an equivalent peak cortisol value to 250 mu g ACTH in patients with activated HPA axis. The cortisol levels obtained at 08:00, 11:00, 17:00 and 24:00 h were significantly higher in the patients than in the controls. This study clearly shows that HPA axis is activated in active pulmonary tuberculosis rather than underactivated. (C) 2000, Editrice Kurtis.