Highlights
- •Tuberculous meningitis is a disease of high morbidity and mortality.
- •Endocrine dysfunction is quite common in tuberculous meningitis.
- •The endocrine dysfunction in TBM adversely affects the clinical outcome.
Abstract
Background
Endocrine dysfunction is known to occur in various infectious diseases of the brain.
The neuroendocrine dysfunction is not well studied in patients of Tuberculous meningitis
(TBM). In this study, we aimed at knowing pattern of endocrine dysfunction in newly
diagnosed patients of tuberculous meningitis, structural changes occurring in hypothalamic-pituitary
region, assessing its predictors and correlative factors related to outcome.
Materials and methods
This was a prospective observational study. All newly diagnosed patients of tuberculous
meningitis were subjected to clinical, laboratory, and hormonal evaluation along with
neuroimaging of hypothalamic-pituitary region. All the patients were treated with
antituberculous drugs along with corticosteroids as per WHO guidelines. The clinical
outcomes of the patients were assessed at the end of 3 months.
Results
Out of 115 patients enrolled in the study, endocrine dysfunction was seen in 62 (53.9%)
patients. Out of these 62 patients, single axis involvement was seen in 35 (30.4%)
patients, while multiple axis dysfunction was observed in 27 (23.5%) patients. Most
common hormonal axis involved was gonadotropic axis (33.9%) followed by hyperprolactinemia
(22.6%), thyrotropic axis (17.4%), corticotropic axis (13%), SIADH (Syndrome of Inappropriate
Antidiuretic Hormone secretion) (9.6%) and somatotropic axis (7.8%). None had diabetes
insipidus. The presence of multiple cranial nerve palsies, hypotension, stage II and
III of TBM, baseline MBI ≤12 and basal exudates were significantly higher in endocrine dysfunction group, while
the presence of basal exudates independently predicted the occurrence of endocrine
dysfunction on multivariate analysis. Though the poor outcome was significantly higher
in endocrine dysfunction group at the end of 3 months, on multivariate analysis factors independently associated with poor outcome
were the presence of altered sensorium and stage III of TBM.
Conclusion
Endocrine dysfunction occurs in a significant proportion of patients with tuberculous
meningitis. The presence of basal exudates is significantly associated with the occurrence
of endocrine dysfunction. Patients with endocrine dysfunction had a poorer outcome
although it was not an independent predictor of the same nor associated with increased
mortality.
Keywords
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Article Info
Publication History
Published online: June 13, 2017
Accepted:
June 12,
2017
Received in revised form:
May 15,
2017
Received:
March 21,
2017
Identification
Copyright
© 2017 Elsevier B.V. All rights reserved.
