Indicators of adrenal insufficiency in TB-suspect patients presenting with signs and symptoms of adrenal insufficiency at three South African Hospitals in Pretoria

Background: Primary adrenal insufficiency occurs when the function of the adrenal cortex to produce cortisol is impaired. Infections, such as disseminated Tuberculosis (TB) and malignancies, are the major causes of Adrenal Insufficiency (AI) in developing countries. AI is characterized by specific symptoms, signs, and laboratory findings. Objective: To determine indicators of AI in TB-suspect patients presenting with signs and symptoms of AI. Methods: A cross-sectional study was conducted at the primary health care ward of Dr. George Mukhari Academic Hospital, Jubilee District Hospital, and Odi District Hospital. The population comprised all TB-suspects, from whom a sample of 75respondents was obtained. A researcher administered questionnaire was used to collect data related to their signs, symptoms, and laboratory findings. Results: Of the 75 respondents, 47 (62.37) and 28 (37.3%) were classified as Adrenal Sufficiency (AS) and AI, respectively. The most occurring symptoms were craving for salt, dry, itchy skin, and vomiting (prevalence: 79.7%, 68.1%, and 69.0%, respectively). Signs or symptoms by themselves did not discriminate persons with a high likelihood of AI. However, a fasting serum glucose (≤ 5.25 mmol/L), a positive GeneXpect, a low CD4 count (≤ 274.5 cells/ml), with a combination of signs and symptoms (9.5) constituted a discriminator for AI in TB-suspect patients (87.5% likelihood). Conclusion: A low fasting serum glucose, a positive GeneXpect, a low CD4 count with a minimum of ten signs and symptoms constitute a discriminator for AI in TB-suspect patients, necessitating treatment initiation to save patient lives in laboratory resource-limited settings.