Chapter 28 : Endocrine and Metabolic Aspects of Tuberculosis

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Endocrine and metabolic derangements are infrequent in patients with tuberculosis, but they are important when they occur. When infection is not isolated to the adrenals, the most common extra-adrenal manifestations are pulmonary and genitourinary tuberculosis. The potential causes of tuberculosis-associated hyponatremia include adrenal insufficiency, the syndrome of inappropriate antidiuretic hormone (SIADH), and cerebral salt wasting. The degree of hyponatremia is variable in patients with tuberculosis, and most patients are asymptomatic. In the vast majority of patients, hyponatremia resolves concurrently with response to antituberculosis therapy. In one large series of patients from Hong Kong, 6% of patients with confirmed hypercalcemia had tuberculosis. The actual prevalence of hypercalcemia in patients with tuberculosis is difficult to estimate, as concurrent serum albumin levels are not always reported. The majority of the reports of hypercalcemia are for patients with pulmonary tuberculosis, perhaps reflecting the preponderance of pulmonary infection over infection at other sites. The physiological role for macrophage production of 1,25-dihydroxyvitamin D is uncertain. According to one proposed mechanism, 1,25-dihydroxyvitamin D enhances the antimycobacterial activity of the monocyte, either as a direct effect or by enhancing cellular responses to gamma interferon. Diabetes may lead to increased susceptibility to tuberculosis through several mechanisms. Diabetic patients demonstrate impaired granulocyte chemotaxis, phagocytosis, bactericidal activity, and superoxide production. The endocrine and metabolic manifestations of tuberculosis are protean. Direct involvement of endocrine glands is only one way in which tuberculosis can affect hormonal and metabolic function.

Citation: Vinnard C, Blumberg E. 2011. Endocrine and Metabolic Aspects of Tuberculosis, p 436-447. In Schlossberg D (ed), Tuberculosis and Nontuberculous Mycobacterial Infections, Sixth Edition. ASM Press, Washington, DC. doi: 10.1128/9781555817138.ch28
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1. Abbasi, A. A.,, J. K. Chemplavil,, S. Farah,, B. F. Muller,, and A. R. Arnstein. 1979. Hypercalcemia in active pulmonary tuberculosis. Ann. Intern. Med. 90: 324328.
2. Alisjahbana, B.,, E. Sahiratmadja,, E. J. Nelwan,, A. M. Purwa,, Y. Ahmad,, T. H. Ottenhoff,, R. H. Nelwan,, I. Parwati,, J. W. van der Meer,, and R. van Crevel. 2007. The effect of type 2 diabetes mellitus on the presentation and treatment response of pulmonary tuberculosis. Clin. Infect. Dis. 45: 428435.
3. Alvarez, S.,, and W. R. McCabe. 1984. Extrapulmonary tuberculosis revisited: a review of experience at Boston City and other hospitals. Medicine (Baltimore) 63: 2555.
4. American Thoracic Society. 2000. Targeted tuberculin testing and treatment of latent tuberculosis infection. Am. J. Respir. Crit. Care Med. 161: S221S247.
5. American Thoracic Society/Centers for Disease Control and Prevention/Infectious Disease Society of America. 2003. Treatment of tuberculosis. Am. J. Respir. Crit. Care Med. 167: 603662.
6. Anderson, R. J.,, R. G. Pluss,, A. S. Berns,, J. T. Jackson,, P. E. Arnold,, R. W. Schrier,, and K. E. McDonald. 1978. Mechanism of effect of hypoxia on renal water excretion. J. Clin. Investig. 62: 769777.
7. Andonopoulos, A. P.,, C. Safridi,, D. Karokis,, and A. Bounas. 1998. Is a purified protein derivative skin and subsequent antituberculous chemoprophylaxis really necessary in systemic rheumatic disease patients receiving corticosteroids? Clin. Rheumatol. 17: 181185.
8. Annear, T. D.,, and G. P. Baker. 1961. Tuberculous Addison’s disease. A case apparently cured by chemotherapy. Lancet ii: 577578.
9. Bacakoglu, F.,, O. K. Basoglu,, G. Cok,, A. Sayiner,, and M. Ates. 2001. Pulmonary tuberculosis in patients with diabetes mellitus. Respiration 68: 595600.
10. Bahceciler, N. N.,, Y. Nuhoglu,, M. A. Nursoy,, N. Kodalli,, I. B. Barlan,, and M. M. Basaran. 2000. Inhaled corticosteroid therapy is safe in tuberculin-positive asthmatic children. Pediatr. Infect. Dis. J. 19: 215218.
11. Barnes, P.,, and R. Weatherstone. 1979. Tuberculosis of the thyroid: two case reports. Br. J. Dis. Chest 73: 187191.
12. Bashar, M.,, P. Alcabes,, W. N. Rom,, and R. Condos. 2001. Increased incidence of multidrug-resistant tuberculosis in diabetic patients on the Bellevue Chest Service, 1987 to 1997. Chest 120: 15141519.
13. Beadsworth, M. B.,, J. J. van Oosterhout,, M. J. Diver,, E. B. Faragher,, A. Shenkin,, H. C. Mwandumba,, S. Khoo,, T. O’Dempsey,, S. B. Squire,, and E. E. Zijlstra. 2008. Hypoadrenalism is not associated with early mortality during tuberculosis treatment in Malawi. Int. J. Tuberc. Lung Dis. 12: 314318.
14. Benini, F.,, T. Savarin,, G. E. Senna,, S. Durigato,, and L. Vettore. 1990. Diagnostic and therapeutic problems in a case of adrenal tuberculosis and acute Addison’s disease. J. Endocrinol. Investig. 13: 597600.
15. Berger, H. W.,, and M. G. Granada. 1974. Lower lung field tuberculosis. Chest 65: 522526.
16. Berger, S. A.,, S. C. Edberg,, and G. David. 1986. Infectious disease in the sella turcica. Rev. Infect. Dis. 8: 747755.
17. Berger, S. A.,, J. Zonszein,, P. Villamena,, and N. Mittman. 1983. Infectious diseases of the thyroid gland. Rev. Infect. Dis. 5: 108122.
18. Beth Gadkowski, L.,, and J. E. Stout. 2007. Pharmacokinetics of rifampicin. Clin. Infect. Dis. 44: 618619. (Author’s reply, 44: 619.)
19. Bhatia, E.,, S. K. Jain,, R. K. Gupta,, and R. Pandey. 1998. Tuberculous Addison’s disease: lack of normalization of adrenocortical function after antituberculous chemotherapy. Clin. Endocrinol. (Oxford) 48: 355359.
20. Boucot, K.,, P. Cooper,, and E. Dillon. 1952. Tuberculosis among diabetics. The Philadelphia survey. Am. Rev. Tuberc. 65: 1.
21. Boucot, K. R. 1957. Diabetes mellitus and pulmonary tuberculosis. J. Chronic Dis. 6: 256279.
22. Bovornkitti, S.,, P. Kangsadal,, P. Sathirapat,, and P. Oonsombatti. 1960. Reversion and reconversion rate of tuberculin skin reactions in correction with the use of prednisone. Dis. Chest 38: 5155.
23. Braman, S. S.,, A. L. Goldman,, and M. I. Schwarz. 1973. Steroid-responsive hypercalcemia in disseminated bone tuberculosis. Arch. Intern. Med. 132: 269271.
24. British Thoracic Association. 1981. A controlled trial of six months of chemotherapy in pulmonary tuberculosis. Br. J. Dis. Chest 75: 141153.
25. Brodie, M. J.,, A. R. Boobis,, C. J. Hillyard,, G. Abeyasekera,, J. C. Stevenson,, I. MacIntyre,, and B. K. Park. 1982. Effect of rifampicin and isoniazid on vitamin D metabolism. Clin. Pharmacol. Ther. 32: 525530.
26. Brooks, M. H.,, J. S. Dumlao,, D. Bronsky,, and S. S. Waldstein. 1973. Hypophysial tuberculoma with hypopituitarism. Am. J. Med. 54: 777781.
27. Bulbuloglu, E.,, H. Ciralik,, E. Okur,, G. Ozdemir,, F. Ezberci,, and A. Cetinkaya. 2006. Tuberculosis of the thyroid gland: review of the literature. World J. Surg. 30: 149155.
28. Buxi, T. B.,, R. B. Vohra,, Sujatha,, S. P. Byotra,, S. Mukherji,, and M. Daniel. 1992. CT in adrenal enlargement due to tuberculosis: a review of literature with five new cases. Clin. Imaging 16: 102108.
29. Cadranel, J.,, A. J. Hance,, B. Milleron,, F. Paillard,, G. M. Akoun,, and M. Garabedian. 1988. Vitamin D metabolism in tuberculosis. Production of 1,25(OH)2D3 by cells recovered by bronchoalveolar lavage and the role of this metabolite in calcium homeostasis. Am. Rev. Respir. Dis. 138: 984989.
30. Camous, L.,, N. Valin,, J. L. Zaragoza,, E. Bourry,, E. Caumes,, G. Deray,, and H. Izzedine. 2008. Hyponatraemic syndrome in a patient with tuberculosis—always the adrenals? Nephrol. Dial. Transplant. 23: 393395.
31. Casey, J. I.,, B. J. Heeter,, and K. A. Klyshevich. 1977. Impaired response of lymphocytes of diabetic subjects to antigen of Staphylococcus aureus. J. Infect. Dis. 136: 495501.
32. Celik, U. S.,, D. Alabaz,, D. Yildizdas,, E. Alhan,, E. Kocabas,, and S. Ulutan. 2005. Cerebral salt wasting in tuberculous meningitis: treatment with fludrocortisone. Ann. Trop. Paediatr. 25: 297302.
33. Chang, J. M.,, M. C. Kuo,, H. T. Kuo,, S. J. Hwang,, J. C. Tsai,, H. C. Chen,, and Y. H. Lai. 2004. 1-α, 25-Dihydroxyvitamin D3 regulates inducible nitric oxide synthase messenger RNA expression and nitric oxide release in macrophage-like RAW 264.7 cells. J. Lab. Clin. Med. 143: 1422.
34. Chow, C. C.,, T. W. Mak,, C. H. Chan,, and C. S. Cockram. 1995. Euthyroid sick syndrome in pulmonary tuberculosis before and after treatment. Ann. Clin. Biochem. 32 (Pt. 4) : 385391.
35. Chung, D. K.,, and W. W. Hubbard. 1969. Hyponatremia in untreated active pulmonary tuberculosis. Am. Rev. Respir. Dis. 99: 595597.
36. Coleman, E. N.,, and G. C. Arneil. 1962. Acute tuberculous adrenocortical failure with clinical recovery. Lancet i: 886888.
37. The Committee on Therapy. 1968. Adrenal corticosteroids and tuberculosis. Am. Rev. Respir. Dis. 97: 484485.
38. Cooper, M. S.,, and P. M. Stewart. 2003. Corticosteroid insufficiency in acutely ill patients. N. Engl. J. Med. 348: 727734.
39. Cotton, M. F.,, P. R. Donald,, J. F. Schoeman,, C. Aalbers,, L. E. Van Zyl,, and C. Lombard. 1991. Plasma arginine vasopressin and the syndrome of inappropriate antidiuretic hormone secretion in tuberculous meningitis. Pediatr. Infect. Dis. J. 10: 837842.
40. Cotton, M. F.,, P. R. Donald,, J. F. Schoeman,, L. E. Van Zyl,, C. Aalbers,, and C. J. Lombard. 1993. Raised intracranial pressure, the syndrome of inappropriate antidiuretic hormone secretion, and arginine vasopressin in tuberculous meningitis. Childs Nerv. Syst. 9: 1015; discussion, 1516.
41. Das, D. K.,, C. S. Pant,, K. L. Chachra,, and A. K. Gupta. 1992. Fine needle aspiration cytology diagnosis of tuberculous thyroiditis. A report of eight cases. Acta Cytol. 36: 517522.
42. Dass, R.,, R. Nagaraj,, J. Murlidharan,, and S. Singhi. 2003. Hyponatraemia and hypovolemic shock with tuberculous meningitis. Indian J. Pediatr. 70: 995997.
43. Davies, P. D.,, H. A. Church,, R. C. Brown,, and J. S. Woodhead. 1987. Raised serum calcium in tuberculosis patients in Africa. Eur. J. Respir. Dis. 71: 341344.
44. Delsedime, M.,, M. Aguggia,, R. Cantello,, I. Chiado Cutin,, G. Nicola,, R. Torta,, and M. Gilli. 1988. Isolated hypophyseal tuberculoma: case report. Clin. Neuropathol. 7: 311313.
45. Dooley, K. E.,, T. Tang,, J. E. Golub,, S. E. Dorman,, and W. Cronin. 2009. Impact of diabetes mellitus on treatment outcomes of patients with active tuberculosis. Am. J. Trop. Med. Hyg. 80: 634639.
46. Doppman, J. L.,, J. R. Gill, Jr.,, A. W. Nienhuis,, J. M. Earll,, and J. A. Long, Jr. 1982. CT findings in Addison’s disease. J. Comput. Assist. Tomogr. 6: 757761.
47. Edwards, O. M.,, R. J. Courtenay-Evans,, J. M. Galley,, J. Hunter,, and A. D. Tait. 1974. Changes in cortisol metabolism following rifampicin therapy. Lancet ii: 548551.
48. Ellison, D. H.,, and T. Berl. 2007. Clinical practice. The syndrome of inappropriate antidiuresis. N. Engl. J. Med. 356: 20642072.
49. El Malki, H. O.,, R. Mohsine,, K. Benkhraba,, M. Amahzoune,, A. Benkabbou,, M. El Absi,, L. Ifrine,, A. Belkouchi,, and S. Balafrej. 2006. Thyroid tuberculosis: diagnosis and treatment. Chemotherapy 52: 4649.
50. Emery, P. 1980. Tuberculous abscess of the thyroid with recurrent laryngeal nerve palsy: case report and review of the literature. J. Laryngol. Otol. 94: 553558.
51. Ezung, T.,, N. T. Devi,, N. T. Singh,, and T. B. Singh. 2002. Pulmonary tuberculosis and diabetes mellitus—a study. J. Indian Med. Assoc. 100: 376, 378379.
52. Felsenfeld, A. J.,, M. K. Drezner,, and F. Llach. 1986. Hypercalcemia and elevated calcitriol in a maintenance dialysis patient with tuberculosis. Arch. Intern. Med. 146: 19411945.
53. Ferrand, R. A.,, A. Elgalib,, W. Newsholme,, A. Childerhouse,, S. G. Edwards,, and R. F. Miller. 2006. Hypercalcaemia complicating immune reconstitution in an HIV-infected patient with disseminated tuberculosis. Int. J. STD AIDS 17: 349350.
54. Fisher-Hoch, S. P.,, E. Whitney,, J. B. McCormick,, G. Crespo,, B. Smith,, M. H. Rahbar,, and B. I. Restrepo. 2008. Type 2 diabetes and multidrug-resistant tuberculosis. Scand. J. Infect. Dis. 40: 888893.
55. Flannery, M. T.,, S. Pattani,, P. M. Wallach,, and E. Warner. 1993. Case report: hypothalamic tuberculoma associated with secondary panhypopituitarism. Am. J. Med. Sci. 306: 101103.
56. Fuss, M.,, R. Karmali,, T. Pepersack,, A. Bergans,, P. Dierckx,, T. Prigogine,, P. Bergmann,, and J. Corvilain. 1988. Are tuberculous patients at a great risk from hypercalcemia? Q. J. Med. 69: 869878.
57. Geisler, C.,, T. Almdal,, J. Bennedsen,, J. M. Rhodes,, and K. Kolendorf. 1982. Monocyte functions in diabetes mellitus. Acta Pathol. Microbiol. Immunol. Scand. C 90: 3337.
58. Gkonos, P. J.,, R. London,, and E. D. Hendler. 1984. Hyper-calcemia and elevated 1,25-dihydroxyvitamin D levels in a patient with end-stage renal disease and active tuberculosis. N. Engl. J. Med. 311: 16831685.
59. Glass, E. J.,, J. Stewart,, D. M. Matthews,, A. Collier,, B. F. Clarke,, and D. M. Weir. 1987. Impairment of monocyte “lectin-like” receptor activity in type 1 (insulin-dependent) diabetic patients. Diabetologia 30: 228231.
60. Gulbas, Z.,, Y. Erdogan,, and S. Balci. 1987. Impaired glucose tolerance in pulmonary tuberculosis. Eur. J. Respir. Dis. 71: 345347.
61. Guo, Y. K.,, Z. G. Yang,, Y. Li,, E. S. Ma,, Y. P. Deng,, P. Q. Min,, L. L. Yin,, J. Hu,, X. C. Zhang,, and T. W. Chen. 2007. Addison’s disease due to adrenal tuberculosis: contrast-enhanced CT features and clinical duration correlation. Eur. J. Radiol. 62: 126131.
62. Guttman, P. 1930. Addison’s disease: a statistical analysis of 566 cases and a study of pathology. Arch. Pathol. 10: 742745.
63. Hadlock, F. P.,, S. K. Park,, R. J. Awe,, and M. Rivera. 1980. Unusual radiographic findings in adult pulmonary tuberculosis. Am. J. Roentgenol. 134: 10151018.
64. Haslam, R. H.,, W. W. Winternitz,, and J. Howieson. 1969. Selective hypopituitarism following tuberculous meningitis. Am. J. Dis. Child. 118: 903908.
65. Hawken, M. P.,, J. C. Ojoo,, J. S. Morris,, E. W. Kariuki,, W. A. Githui,, E. S. Juma,, S. N. Gathua,, J. N. Kimari,, L. N. Thiong’o,, J. G. Raynes,, P. Broadbent,, C. F. Gilks,, L. S. Otieno,, and K. P. McAdam. 1996. No increased prevalence of adrenocortical insufficiency in human immunodeficiency virus-associated tuberculosis. Tuber. Lung Dis. 77: 444448.
66. Hill, A. R.,, J. Uribarri,, J. Mann,, and T. Berl. 1990. Altered water metabolism in tuberculosis: role of vasopressin. Am. J. Med. 88: 357364.
67. Hung, Y. M.,, H. H. Chan,, and H. M. Chung. 2004. Tuberculous peritonitis in different dialysis patients in Southern Taiwan. Am. J. Trop. Med. Hyg. 70: 532535.
68. Ikezoe, J.,, N. Takeuchi,, T. Johkoh,, N. Kohno,, N. Tomiyama,, T. Kozuka,, K. Noma,, and E. Ueda. 1992. CT appearance of pulmonary tuberculosis in diabetic and immunocompromised patients: comparison with patients who had no underlying disease. Am. J. Roentgenol. 159: 11751179.
69. Ilias, I.,, A. Tselebis,, A. Boufas,, G. Panoutsopoulos,, N. Filippou,, and J. Christakopoulou. 1998. Pulmonary tuberculosis and its therapy do not significantly affect thyroid function tests. Int. J. Clin. Pract. 52: 227228.
70. Isaacs, R. D.,, G. I. Nicholson,, and I. M. Holdaway. 1987. Miliary tuberculosis with hypercalcaemia and raised vitamin D concentrations. Thorax 42: 555556.
71. Jaakkola, T.,, J. T. Backman,, M. Neuvonen,, J. Laitila,, and P. J. Neuvonen. 2006. Effect of rifampicin on the pharmacokinetics of pioglitazone. Br. J. Clin. Pharmacol. 61: 7078.
72. Jeon, C. Y.,, and M. B. Murray. 2008. Diabetes mellitus increases the risk of active tuberculosis: a systematic review of 13 observational studies. PLoS Med. 5: e152.
73. Jick, S. S.,, E. S. Lieberman,, M. U. Rahman,, and H. K. Choi. 2006. Glucocorticoid use, other associated factors, and the risk of tuberculosis. Arthritis Rheum. 55: 1926.
74. Johnson, A. G.,, M. E. Phillips,, and R. J. Thomas. 1973. Acute tuberculous abscess of the thyroid gland. Br. J. Surg. 60: 668669.
75. Jones, B. E.,, E. K. Taikwel,, A. L. Mercado,, S. U. Sian,, and P. F. Barnes. 1994. Tuberculosis in patients with HIV infection who receive corticosteroids for presumed Pneumocystis carinii pneumonia. Am. J. Respir. Crit. Care Med. 149: 16861688.
76. Kameda, K.,, S. Kawabata,, and N. Masuda. 1990. Follow-up study of short-course chemotherapy of pulmonary tuberculosis complicated with diabetes mellitus. Kekkaku 65: 791803.
77. Kannan, C. 1988. The Adrenal Gland, vol. 2. Plenum Medical Book Company, New York, NY.
78. Kaplan, F. J. L.,, N. S. Levitt,, and S. G. Soule. 2000. Primary hypoadrenalism assessed by the 1 microgram ACTH test in hospitalized patients with active pulmonary tuberculosis. Q. J. Med. 93: 603609.
79. Kapoor, V. K.,, K. Subramani,, S. K. Das,, A. K. Mukhopadhyay,, and T. K. Chattopadhyay. 1985. Tuberculosis of the thyroid gland associated with thyrotoxicosis. Postgrad. Med. J. 61: 339340.
80. Kelestimur, F.,, M. Guven,, M. Ozesmi,, and H. Pasaoglu. 1996. Does tuberculosis really cause hypercalcemia? J. Endocrinol. Investig. 19: 678681.
81. Kelestimur, F.,, O. Ozbakir,, A. Saglam,, F. Ozturk,, and M. Yucesoy. 1993. Acute adrenocortical failure due to tuberculosis. J. Endocrinol. Investig. 16: 281284.
82. Keven, K.,, A. R. Uysal,, and G. Erdogan. 1998. Adrenal function during tuberculous infection and effects of antituberculosis treatment on endogenous and exogenous steroids. Int. J. Tuberc. Lung Dis. 2: 419424.
83. Khan, E. M.,, I. Haque,, R. Pandey,, S. K. Mishra,, and A. K. Sharma. 1993. Tuberculosis of the thyroid gland: a clinico-pathological profile of four cases and review of the literature. Aust. N. Z. J. Surg. 63: 807810.
84. Kim, H. A.,, C. D. Yoo,, H. J. Baek,, E. B. Lee,, C. Ahn,, J. S. Han,, S. Kim,, J. S. Lee,, K. W. Choe,, and Y. W. Song. 1998. Mycobacterium tuberculosis infection in a corticosteroid-treated rheumatic disease patient population. Clin. Exp. Rheumatol. 16: 913.
85. Kirshbaum, J. D.,, and H. A. Levy. 1941. Tuberculoma of hypophysis with insufficiency of anterior lobe: a clinical and pathological study of two cases. Arch. Intern. Med. 68: 10951104.
86. Kitrou, M. P.,, A. Phytou-Pallikari,, S. E. Tzannes,, K. Virvidakis,, and T. D. Mountokalakis. 1982. Hypercalcemia in active pulmonary tuberculosis. Ann. Intern. Med. 96: 255.
87. Koziel, H.,, and M. J. Koziel. 1995. Pulmonary complications of diabetes mellitus. Pneumonia. Infect. Dis. Clin. N. Am. 9: 6596.
88. Kyriazopoulou, V.,, O. Parparousi,, and A. G. Vagenakis. 1984. Rifampicin-induced adrenal crisis in addisonian patients receiving corticosteroid replacement therapy. J. Clin. Endocrinol. Metab. 59: 12041206.
89. Lack, E. E.,, and H. P. W. Kozakewich. 1990. Embryology, developmental anatomy, and selected aspects of nonneoplastic pathology, In E. E. Lack (ed.), Pathology of the Adrenal Glands. Contemporary Issues in Surgical Pathology, vol. 14. Churchill Livingstone, New York, NY.
90. Lam, K. S.,, M. M. Sham,, S. C. Tam,, M. M. Ng,, and H. T. Ma. 1993. Hypopituitarism after tuberculous meningitis in childhood. Ann. Intern. Med. 118: 701706.
91. Lam, K. Y.,, and C. Y. Lo. 2001. A critical examination of adrenal tuberculosis and a 28-year autopsy experience of active tuberculosis. Clin. Endocrinol. (Oxford) 54: 633639.
92. Lawn, S. D.,, and D. C. Macallan. 2004. Hypercalcemia: a manifestation of immune reconstitution complicating tuberculosis in an HIV-infected person. Clin. Infect. Dis. 38: 154155.
93. Lee, C. T.,, K. H. Hung,, C. H. Lee,, H. L. Eng,, and J. B. Chen. 2002. Chronic hypercalcemia as the presenting feature of tuberculous peritonitis in a hemodialysis patient. Am. J. Nephrol. 22: 555559.
94. Lee, P.,, and K. K. Ho. 2010. Hyponatremia in pulmonary TB: evidence of ectopic antidiuretic hormone production. Chest 137: 207208.
95. Liam, C. K.,, K. H. Lim,, P. Srinivas,, and P. J. Poi. 1998. Hypercalcaemia in patients with newly diagnosed tuberculosis in Malaysia. Int. J. Tuberc. Lung Dis. 2: 818823.
96. Lin, S. M.,, S. L. Tsai,, and C. S. Chan. 1994. Hypercalcemia in tuberculous peritonitis without active pulmonary tuberculosis. Am. J. Gastroenterol. 89: 22492250.
97. MacGregor, R. R.,, J. N. Sheagren,, M. B. Lipsett,, and S. M. Wolff. 1969. Alternate-day prednisone therapy. Evaluation of delayed hypersensitivity responses, control of disease and steroid side effects. N. Engl. J. Med. 280: 14271431.
98. Martos, A.,, D. Podzamczer,, J. Martinez-Lacasa,, G. Rufi,, M. Santin,, and F. Gudiol. 1995. Steroids do not enhance the risk of developing tuberculosis or other AIDS-related diseases in HIV-infected patients treated for Pneumocystis carinii pneumonia. AIDS 9: 10371041.
99. Mondal, A.,, and D. K. Patra. 1995. Efficacy of fine needle aspiration cytology in the diagnosis of tuberculosis of the thyroid gland: a study of 18 cases. J. Laryngol. Otol. 109: 3638.
100. Monkawa, T.,, T. Yoshida,, M. Hayashi,, and T. Saruta. 2000. Identification of 25-hydroxyvitamin D3 1α-hydroxylase gene expression in macrophages. Kidney Int. 58: 559568.
101. Morris, C. D.,, A. R. Bird,, and H. Nell. 1989. The haemato-logical and biochemical changes in severe pulmonary tuberculosis. Q. J. Med. 73: 11511159.
102. Mugusi, F.,, A. B. Swai,, K. G. Alberti,, and D. G. McLarty. 1990. Increased prevalence of diabetes mellitus in patients with pulmonary tuberculosis in Tanzania. Tubercle 71: 271276.
103. Munkner, T. 1969. Studies on goitre due to paraaminosalicylic acid. Scand. J. Respir. Dis. 50: 212226.
104. Nagotkar, L.,, P. Shanbag,, and N. Dasarwar. 2008. Cerebral salt wasting syndrome following neurosurgical intervention in tuberculous meningitis. Indian Pediatr. 45: 598601.
105. Need, A. G.,, and P. J. Phillips. 1979. Pulmonary tuberculosis and hypercalcaemia. Ann. Intern. Med. 91: 652653.
106. Niemi, M.,, J. T. Backman,, M. Neuvonen,, P. J. Neuvonen,, and K. T. Kivisto. 2001. Effects of rifampin on the pharmacokinetics and pharmacodynamics of glyburide and glipizide. Clin. Pharmacol. Ther. 69: 400406.
107. Nieuwland, Y.,, K. Y. Tan,, and J. W. Elte. 1992. Miliary tuberculosis presenting with thyrotoxicosis. Postgrad. Med. J. 68: 677679.
108. Nijland, H. M.,, R. Ruslami,, J. E. Stalenhoef,, E. J. Nelwan,, B. Alisjahbana,, R. H. Nelwan,, A. J. van der Ven,, H. Danusantoso,, R. E. Aarnoutse,, and R. van Crevel. 2006. Exposure to rifampicin is strongly reduced in patients with tuberculosis and type 2 diabetes. Clin. Infect. Dis. 43: 848854.
109. Nordin, B. E. 1955. Addison’s disease with partial recovery. Proc. R. Soc. Med. 48: 10241026.
110. Ohnhaus, E. E.,, and H. Studer. 1983. A link between liver microsomal enzyme activity and thyroid hormone metabolism in man. Br. J. Clin. Pharm. 15: 7176.
111. Olmos, P.,, J. Donoso,, N. Rojas,, P. Landeros,, R. Schurmann,, G. Retamal,, M. Meza,, and C. Martinez. 1989. Tuberculosis and diabetes mellitus: a longitudinal-retrospective study in a teaching hospital. Rev. Med. Chil. 117: 979983. (In Spanish.)
112. Oluboyo, P. O.,, and R. T. Erasmus. 1990. The significance of glucose intolerance in pulmonary tuberculosis. Tubercle 71: 135138.
113. Osborne, T. M.,, and M. J. Sage. 1988. Disseminated tuberculosis causing acute adrenal failure, C.T. findings with post mortem correlation. Australas. Radiol. 32: 394397.
114. Palmer, B. F. 2003. Hyponatremia in patients with central nervous system disease: SIADH versus CSW. Trends Endocrinol. Metab. 14: 182187.
115. Peces, R.,, and J. Alvarez. 1987. Hypercalcemia and elevated 1,25(OH)2D3 levels in a dialysis patient with disseminated tuberculosis. Nephron 46: 377379.
116. Perez-Guzman, C.,, A. Torres-Cruz,, H. Villarreal-Velarde,, and M. H. Vargas. 2000. Progressive age-related changes in pulmonary tuberculosis images and the effect of diabetes. Am. J. Respir. Crit. Care Med. 162: 17381740.
117. Post, F. A.,, S. G. Soule,, P. A. Willcox,, and N. S. Levitt. 1994. The spectrum of endocrine dysfunction in active pulmonary tuberculosis. Clin. Endocrinol. (Oxford) 40: 367371.
118. Pozilli, P.,, S. Pagani,, and P. Aruduini. 1987. In vivo determination of cell mediated immune response in diabetic patients using a multiple intradermal antigen dispenser. Diabetes Res. 6: 58.
119. Prasad, G. A.,, S. K. Sharma,, A. Mohan,, N. Gupta,, S. Bajaj,, P. K. Saha,, N. K. Misra,, N. P. Kochupillai,, and J. N. Pande. 2000. Adrenocortical reserve and morphology in tuberculosis. Indian J. Chest Dis. Allied Sci. 42: 8393.
120. Ranjan, A.,, and M. J. Chandy. 1994. Intrasellar tuberculoma. Br. J. Neurosurg. 8: 179185.
121. Rankin, F. W.,, and A. S. Graham. 1932. Tuberculosis of the thyroid gland. Ann. Surg. 96: 625648.
122. Rickards, A. G.,, and P. W. Harvey. 1954. Giant-cell granuloma and the other pituitary granulomata. Q. J. Med. 23: 425439.
123. Roca, B.,, N. Tornador,, and E. Tornador. 2008. Presentation and outcome of tuberculous meningitis in adults in the province of Castellon, Spain: a retrospective study. Epidemiol. Infect. 136: 14551462.
124. Rook, G. A.,, J. Steele,, L. Fraher,, S. Barker,, R. Karmali,, J. O’Riordan,, and J. Stanford. 1986. Vitamin D3, gamma interferon, and control of proliferation of Mycobacterium tuberculosis by human monocytes. Immunology 57: 159163.
125. Roussos, A.,, I. Lagogianni,, A. Gonis,, I. Ilias,, D. Kazi,, D. Patsopoulos,, and N. Philippou. 2001. Hypercalcaemia in Greek patients with tuberculosis before the initiation of antituberculosis treatment. Respir. Med. 95: 187190.
126. Ruslami, R.,, H. M. Nijland,, I. G. Adhiarta,, S. H. Kariadi,, B. Alisjahbana,, R. E. Aarnoutse,, and R. van Crevel. 2010. Pharmacokinetics of antituberculosis drugs in pulmonary tuberculosis patients with type 2 diabetes. Antimicrob. Agents Chemother. 54: 10681074.
127. Saggese, G.,, S. Bertelloni,, G. I. Baroncelli,, and G. Di Nero. 1993. Ketoconazole decreases the serum ionized calcium and 1,25-dihydroxyvitamin D levels in tuberculosis-associated hypercalcemia. Am. J. Dis. Child. 147: 270273.
128. Sanford, J. P.,, and C. B. Favour. 1956. The interrelationships between Addison’s disease and active tuberculosis: a review of 125 cases of Addison’s disease. Ann. Intern. Med. 45: 5672.
129. Schatz, M.,, R. Patterson,, R. Kloner,, and J. Falk. 1976. The prevalence of tuberculosis and positive tuberculin skin tests in a steroid-treated asthmatic population. Ann. Intern. Med. 84: 261265.
130. Schulte, H. M.,, H. Monig,, G. Benker,, H. Pagel,, D. Reinwein,, and E. E. Ohnhaus. 1987. Pharmacokinetics of aldosterone in patients with Addison’s disease: effect of rifampicin treatment on glucocorticoid and mineralocorticoid metabolism. Clin. Endocrinol. (Oxford) 27: 655662.
131. Shai, F.,, R. K. Baker,, J. R. Addrizzo,, and S. Wallach. 1972. Hypercalcemia in mycobacterial infection. J. Clin. Endocrinol. Metab. 34: 251256.
132. Shaikh, W. A. 1992. Pulmonary tuberculosis in patients treated with inhaled beclomethasone. Allergy 47: 327330.
133. Sharma, M. C.,, R. Arora,, A. K. Mahapatra,, P. Sarat-Chandra,, S. B. Gaikwad,, and C. Sarkar. 2000. Intrasellar tuberculoma—an enigmatic pituitary infection: a series of 18 cases. Clin. Neurol. Neurosurg. 102: 7277.
134. Sharma, S. C. 1981. Serum calcium in pulmonary tuberculosis. Postgrad. Med. J. 57: 694696.
135. Shek, C. C.,, A. Natkunam,, V. Tsang,, C. S. Cockram,, and R. Swaminathan. 1990. Incidence, causes and mechanism of hypercalcaemia in a hospital population in Hong Kong. Q. J. Med. 77: 12771285.
136. Sherman, B. M.,, P. Gorden,, and G. di Chiro. 1971. Postmeningitis selective hypopituitarism with suprasellar calcification. Arch. Intern. Med. 128: 600604.
137. Singh, S.,, D. Bohn,, A. P. Carlotti,, M. Cusimano,, J. T. Rutka,, and M. L. Halperin. 2002. Cerebral salt wasting: truths, fallacies, theories, and challenges. Crit. Care Med. 30: 25752579.
138. Singla, R.,, and N. Khan. 2003. Does diabetes predispose to the development of multidrug-resistant tuberculosis? Chest 123: 308309. (Author’s reply, 123: 309.)
139. Slavin, R. E.,, T. J. Walsh,, and A. D. Pollack. 1980. Late generalized tuberculosis: a clinical pathologic analysis and comparison of 100 cases in the preantibiotic and antibiotic eras. Medicine (Baltimore) 59: 352366.
140. Sosman, M. C.,, and J. H. Steidl. 1927. Diabetic tuberculosis. Am. J. Roentgenol. 17: 625629.
141. Stalldecker, G.,, S. Diez,, A. Carabelli,, R. Reynoso,, R. Rey,, N. Hofmann,, and A. Beresnak. 2002. Pituitary stalk tuberculoma. Pituitary 5: 155162.
142. Stewart, P. M. 2003. The adrenal cortex, p. 491–551. In P. R. Larsen,, H. M. Kronenberg,, S. Melmed, and, K. S. Polonsky (ed.), Williams Textbook of Endocrinology, 10th ed. Saunders, Philadelphia, PA.
143. Suarez-Garcia, I.,, A. Rodriguez-Blanco,, J. L. Vidal-Perez,, M. A. Garcia-Viejo,, M. J. Jaras-Hernandez,, O. Lopez,, and A. Noguerado-Asensio. 2009. Risk factors for multidrug-resistant tuberculosis in a tuberculosis unit in Madrid, Spain. Eur. J. Clin. Microbiol. Infect. Dis. 28: 325330.
144. Subhash, H. S.,, I. Ashwin,, U. Mukundan,, D. Danda,, G. John,, A. M. Cherian,, and K. Thomas. 2003. Drug resistant tuberculosis in diabetes mellitus: a retrospective study from south India. Trop. Doct. 33: 154156.
145. Sullivan, J. N.,, and W. D. Salmon, Jr. 1987. Hypercalcemia in active pulmonary tuberculosis. South. Med. J. 80: 572576.
146. Swai, A. B.,, D. G. McLarty,, and F. Mugusi. 1990. Tuberculosis in diabetic patients in Tanzania. Trop. Doct. 20: 147150.
147. Tanrikulu, A. C.,, S. Hosoglu,, T. Ozekinci,, A. Abakay,, and F. Gurkan. 2008. Risk factors for drug resistant tuberculosis in southeast Turkey. Trop. Doct. 38: 9193.
148. Tatar, D.,, G. Senol,, S. Alptekin,, C. Karakurum,, M. Aydin,, and I. Coskunol. 2009. Tuberculosis in diabetics: features in an endemic area. Jpn. J. Infect. Dis. 62: 423427.
149. Ti, L. K.,, S. C. Kang,, and K. F. Cheong. 1998. Acute hyponatraemia secondary to cerebral salt wasting syndrome in a patient with tuberculous meningitis. Anaesth. Intensive Care 26: 420423.
150. Truelove, L. H. 1957. Enhancement of Mantoux reaction coincident with treatment with cortisone and prednisolone. Br. Med. J. 2: 11351137.
151. Venter, W. D. F.,, V. R. Panz,, C. Feldman,, and B. I. Joffe. 2006. Adrenocortical function in hospitalised patients with active pulmonary tuberculosis receiving a rifampicin-based regimen—a pilot study. S. Afr. Med. J. 96: 6266.
152. Vita, J. A.,, S. J. Silverberg,, R. S. Goland,, J. H. Austin,, and A. I. Knowlton. 1985. Clinical clues to the cause of Addison’s disease. Am. J. Med. 78: 461466.
153. Wang, C. S.,, C. J. Yang,, H. C. Chen,, S. H. Chuang,, I. W. Chong,, J. J. Hwang,, and M. S. Huang. 2009. Impact of type 2 diabetes on manifestations and treatment outcome of pulmonary tuberculosis. Epidemiol. Infect. 137: 203210.
154. Ward, S.,, and C. C. Evans. 1985. Sudden death due to isolated adrenal tuberculosis. Postgrad. Med. J. 61: 635636.
155. Weiss, H.,, and S. Katz. 1965. Hyponatremia resulting from apparently inappropriate secretion of antidiuretic hormone in patients with pulmonary tuberculosis. Am. Rev. Respir. Dis. 92: 609616.
156. Wilkins, E. G.,, E. Hnizdo,, and A. Cope. 1989. Addisonian crisis induced by treatment with rifampicin. Tubercle 70: 6973.
157. Wong, L. L.,, and J. G. Verbalis. 2002. Systemic diseases associated with disorders of water homeostasis. Endocrinol. Metab. Clin. N. Am. 31: 121140.
158. Wyllie, J. P.,, A. J. Chippindale,, and A. J. Cant. 1993. Miliary tuberculosis and symptomatic hypercalcemia. Pediatr. Infect. Dis. J. 12: 780782.
159. Yokoyama, T.,, R. Toda,, Y. Kimura,, M. Mikagi,, and H. Aizawa. 2009. Addison’s disease induced by miliary tuberculosis and the administration of rifampicin. Intern. Med. 48: 12971300.
160. Yonemura, K.,, T. Ohtake,, H. Matsushima,, Y. Fujigaki,, and A. Hishida. 2004. High ratio of 1,25-dihydroxyvitamin D3 to parathyroid hormone in serum of tuberculous patients with end-stage renal disease. Clin. Nephrol. 62: 202207.
161. Zargar, A. H.,, F. A. Sofi,, M. A. Akhtar,, M. Salahuddin,, S. R. Masoodi,, and B. A. Laway. 2001. Adrenocortical reserve in patients with active tuberculosis. J. Pak. Med. Assoc. 51: 427433.
162. Zhang, X. C.,, Z. G. Yang,, Y. Li,, P. Q. Min,, Y. K. Guo,, Y. P. Deng,, and Z. H. Dong. 2008. Addison’s disease due to adrenal tuberculosis: MRI features. Abdom. Imaging 33: 689694.

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