AI Summary & Key Takeaways
AI InsightThe standard anti-TB treatment including rifampicin, which is a potent inducer of the microsomal enzymes involved in steroid metabolism, can induce the primary adrenal insufficiency in the patients with TB.
📌 3 Key Takeaways
Abstract
Addisonian crisis is the acute fatal complication of Addisonian disease. Fifty six years old female patient with complaints of cough, sputum, hypotension, loss of weight and appetite was admitted to hospital. Standard antituberculosis (anti-TB) treatment including rifampicin was started to the patient with the diagnosis of lung TB. At the third day of the treatment the patient had vomiting, body contractions, and at the fifth day she had unconsiousness, hypoglisemia, hyponatremia and mucosal pigmentation. She was diagnosed as Addisonian crisis with elevated adrenocorticotropic hormone (ACTH) and decreased serum cortisole levels. Additionally a partial hypopituitarism with hypogonadotropic hypogonadism and secondary hypothyroidism was established at the patient who described postpartum menopause while she was 25 years old (Sheehan syndrome). The pituitary magnetic resonance imaging (MRI) revealed empty sella. The anti-TB treatment asssociated with steroid replacement was restarted to the patient whose sputum AFB culture was found (+) and she recovered clinically and radiologically six months later. The standard anti-TB treatment including rifampicin, which is a potent inducer of the microsomal enzymes involved in steroid metabolism, can induce the primary adrenal insufficiency in the patients with TB.
Özet
Addison krizi, Addison hastalığının hayatı tehdit edici akut komplikasyonudur. Öksürük, balgam, hipotansiyon, kilo kaybı, iştahsızlık şikayetleriyle başvuran 56 yaşındaki kadın hastaya akciğer tüberküloz (TB)’u tanısı ile rifampisin içeren standart anti-TB tedavi başlandı ve tedavinin üçüncü gününde bulantı, vücutta kasılmalar ve beşinci gününde bilinç kaybı, hiponatremi, hipoglisemi, mukozal pigmentasyon gelişti. Adrenokortikotropik hormon (ACTH) yüksekliği ve serum kortizol düşüklüğü ile Addison krizi tanısı kondu. Öyküsünde 25 yaşında postpartum menopoz tarifleyen hastada ek olarak parsiyel bir hipopitüitarizm (Sheehan sendromu) ile uyumlu hipogonadotropik hipogonadizm ve sekonder hipotiroidi, hipofiz manyetik rezonans (MR)’da ise empty sella görünümü saptandı. Balgam asidorezistan basil (ARB) kültürü pozitif bulunan hastaya steroid replasmanı eşliğinde tekrar anti-TB tedavi başlandı ve altı ay sonra klinik, radyolojik düzelme sağlandı. Potent bir mikrozomal enzim indüktörü olan rifampisin içermesi nedeniyle standart anti-TB tedavi, TB’li hastalarda primer adrenal yetmezlik kliniğini indükleyebilmektedir.