Prospective investigation of the hypothalamo–pituitary–adrenal axis in patients with tularemia

Background/aim: To investigate prospectively the hypothalamo–pituitary–adrenal (HPA) axis by adrenocorticotropic hormone (ACTH) stimulation test. Materials and methods: Tularemia was diagnosed according to guidelines. An ACTH stimulation test (1 μg) and a dexamethasone suppression test (DST; 1 mg) were performed in patients in the acute phase of tularemia before antibiotic treatment and in the chronic phase. Results: Nineteen patients (mean age: 41.0 ± 13.2 years; 57.9% female) with tularemia were enrolled in the study in 2011 and 2012. Cortisol response to ACTH stimulation test was sufficient in all patients during the acute phase. After the DST, the cortisol was not suppressed during the acute phase in only one patient. The median control time of 11 patients after acute tularemia was 13 months. During the chronic phase, cortisol response to ACTH stimulation was normal in all patients, and after DST cortisol was suppressed in all patients. The peak cortisol level after the ACTH stimulation test in the acute phase was higher than that in the chronic phase, but the difference was not statistically significant. Conclusion: The HPA axis of patients with tularemia was not significantly affected in the acute and chronic phases.