{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T13:02:30Z","timestamp":1771851750683,"version":"3.50.1"},"reference-count":32,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2025,6,2]],"date-time":"2025-06-02T00:00:00Z","timestamp":1748822400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background and Objectives<\/jats:title><jats:p>Adrenal insufficiency (AI) is a recognized complication in tuberculosis (TB), with previous studies reporting a highly variable prevalence (0%\u201376%), primarily during or after antitubercular treatment (ATT). However, data on AI prevalence in treatment\u2010na\u00efve TB patients remains scarce. This study aimed to determine the prevalence of AI and adrenal gland morphology in adult patients with newly diagnosed, treatment\u2010na\u00efve TB.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and Methods<\/jats:title><jats:p>This cross\u2010sectional study included 100 treatment\u2010na\u00efve adult TB patients attending the Revised National Tuberculosis Control Program (RNTCP) clinic at Government Medical College Hospital, Thiruvananthapuram, and Chest Disease Hospital, Pulayanarkotta. Patients with HIV, uncontrolled diabetes, critical illness, or recent steroid use were excluded. Due to the COVID\u201019 pandemic, patient attendance was limited. Clinical features suggestive of AI were assessed based on symptoms and laboratory findings, including hyponatremia and hyperkalemia. An ACTH stimulation test was performed using 0.5\u2009mL (30 units) of long\u2010acting porcine ACTH (Acton Prolongatum) intramuscularly. Serum cortisol levels were measured at 60 and 120\u2009min after administration. AI was defined as a peak cortisol level below 17\u2009\u03bcg\/dL at 60\u2009min and below 19.5\u2009\u03bcg\/dL at 120\u2009min. Contrast\u2010enhanced CT (CECT) Abdomen or Thorax images were analyzed for adrenal morphology in one AI\u2010diagnosed TB patient and a subset of 14 TB patients without AI, and 18 age\u2010matched healthy controls without TB or chronic lung pathology.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Among 100 patients (88% pulmonary TB [PTB], 12% extrapulmonary TB[EPTB]) with a mean age of 50\u2009\u00b1\u200915.4 years and a male\u2010to\u2010female ratio of 3.1:1, 27 patients (27%) exhibited clinical features suggestive of AI. The mean peak serum cortisol levels were 35.17\u2009\u00b1\u200910.77\u2009\u03bcg\/dL at 60\u2009min and 39.67\u2009\u00b1\u200910.84\u2009\u03bcg\/dL at 120\u2009min. AI was diagnosed in one patient with EPTB (1%), while none of the patients with PTB had AI. CT analysis revealed significantly reduced right adrenal Hounsfield unit (HU) density (<jats:italic>p<\/jats:italic>\u2009=\u20090.02) and lateral limb thickness (<jats:italic>p<\/jats:italic>\u2009=\u20090.01) in TB patients versus controls, despite absent adrenal enlargement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>AI is rare (1%) in treatment\u2010na\u00efve TB patients despite the overlapping clinical features in a significant proportion. Subtle adrenal morphological changes without enlargement suggest early TB\u2010related alterations without overt dysfunction. Future research should prioritize larger TB cohorts including Extrapulmonary TB to enhance detection of adrenal pathology while minimizing radiation exposure with detailed immune assessments.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.15282","type":"journal-article","created":{"date-parts":[[2025,6,3]],"date-time":"2025-06-03T01:24:31Z","timestamp":1748913871000},"page":"436-446","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Prevalence of Adrenal Insufficiency and Adrenal Morphology in Treatment\u2010Na\u00efve Tuberculosis Patients: A Cross\u2010Sectional Study From a High\u2010Burden Region"],"prefix":"10.1111","volume":"103","author":[{"ORCID":"https:\/\/orcid.org\/0009-0005-8106-4739","authenticated-orcid":false,"given":"Ajeesh","family":"Thulaseedharan","sequence":"first","affiliation":[{"name":"Government Medical College Thiruvananthapuram Kerala India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Puthiyaveettil Khadar","family":"Jabbar","sequence":"additional","affiliation":[{"name":"Government Medical College Thiruvananthapuram Kerala India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sanjeev","family":"Nair","sequence":"additional","affiliation":[{"name":"Government Medical College Thiruvananthapuram Kerala India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chellamma","family":"Jayakumari","sequence":"additional","affiliation":[{"name":"Government Medical College Thiruvananthapuram Kerala India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sree Priya Pankajakshan","family":"Rema","sequence":"additional","affiliation":[{"name":"Government Medical College Thiruvananthapuram Kerala India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Darvin Vamadevan","family":"Das","sequence":"additional","affiliation":[{"name":"Government Medical College Thiruvananthapuram Kerala India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ramesh","family":"Gomez","sequence":"additional","affiliation":[{"name":"Government Medical College Thiruvananthapuram Kerala India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sankar","family":"Sethuraman","sequence":"additional","affiliation":[{"name":"Government Medical College Thiruvananthapuram Kerala India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3082-8020","authenticated-orcid":false,"given":"Soumya","family":"Sarayu","sequence":"additional","affiliation":[{"name":"Government Medical College Thiruvananthapuram Kerala India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6776-1582","authenticated-orcid":false,"given":"Abilash","family":"Nair","sequence":"additional","affiliation":[{"name":"Government Medical College Thiruvananthapuram Kerala India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,6,2]]},"reference":[{"key":"e_1_2_7_2_1","volume-title":"Global Tuberculosis Report 2021","author":"World Health Organization","year":"2021"},{"key":"e_1_2_7_3_1","unstructured":"India TB report 2022. \u201cCentral TB Division Ministry of Health and Family Welfare Government of India \u201d2022."},{"key":"e_1_2_7_4_1","volume-title":"On the Constitutional and Local Effects of Disease of the Supra\u2010Renal Capsules","author":"Addison T.","year":"1855"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/B978-0-323-29738-7.00015-0"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.4161\/auto.44.3.15106"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF03346466"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(03)13457-2"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.radcr.2020.10.035"},{"issue":"4","key":"e_1_2_7_10_1","first-page":"316","article-title":"Extrapulmonary Tuberculosis","volume":"120","author":"Sharma S. 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