A systematic review of adrenal insufficiency among patients with pulmonary tuberculosis in Sub-Saharan Africa

Abstract

Introduction: Tuberculosis (TB) is a disease of public health importance globally. The incidence of pulmonary TB is rising in sub-Saharan Africa. Bilateral adrenal destruction and the use of medications such as rifampicin are possible mechanisms by which TB cause adrenal insufficiency. Failure to promptly recognize adrenal insufficiency may lead to a medical crisis causing death. This systematic review aimed to identify the frequency of adrenal insufficiency, the clinical presentation and its predictors in patients with pulmonary TB in sub-Saharan Africa. Methods: The study was a systematic review. Medical databases and the grey literature were searched. Literature search and studies selection were done following the PRISMA guidelines. Results: The total sample size was 809. The frequency of adrenal insufficiency among patients with pulmonary TB in sub-Saharan Africa was 0.9%–59.8%. Patients with adrenal insufficiency had symptoms such as nausea, vomiting, darkening of the skin, salt craving, and weight loss. Other symptoms were dry, itchy skin, abdominal pain, and muscle pain. The predictors of adrenal insufficiency among patients with pulmonary TB in sub-Saharan Africa were low blood pressure, low blood glucose, presence of multidrug-resistant TB, and low CD4 count. Other predictors were abdominal pain and generalized skin hyperpigmentation. Conclusion: The frequency of adrenal insufficiency in patients with pulmonary TB can be as high as 50%. The presence of low blood pressure, low blood glucose, multidrug-resistant TB, and generalized skin hyperpigmentation is a pointer to the possibility of adrenal insufficiency in these patients.

Keywords

• adrenal insufficiency
• pulmonary tuberculosis
• sub-saharan africa
• systematic review