TB and adrenal insufficiency

Although TB is one of the leading causes of adrenal insufficiency in the world and should be considered in patients presenting with shock and a history suggestive of TB,1 the index of suspicion for adrenal insufficiency was quite low in the case that we reported.2 Although the patient was initially hypotensive, his blood pressure did respond to fluid administration, and his electrolyte levels were initially normal. In contrast, patients in adrenal crisis usually require steroid treatment and do not respond readily to fluids. Furthermore, the patient underwent multiple CT examinations of the abdomen, all of which showed that the adrenal glands were normal. We did not check the patient's cortisol level, nor did we do corticotropin stimulation test, as it was extremely unlikely that the patient had adrenal insufficiency. Nonetheless, we thank Wael Haddara and Stan van Uum for describing this important point.

Ronik Kanani Aleixo Muise Department of Paediatrics Hospital for Sick Children Toronto, Ont.