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OBJECTIVE The aim: To establish the clinical and pathogenetic role of glucocorticoid imbalance as an important link of impairment of the adaptive system homeostasis and to determine ways of its correction as a way to increase the effectiveness of the pulmonary tuberculosis treatment. PATIENTS AND METHODS Materials and methods: The effectiveness of glucocorticoids in the pulmonary tuberculosis treatment was studied in 304 patients, of which 134 patients (group 1) received only antibacterial therapy, 67 patients (group 2) were supplemented with glucocorticoids (20-30 mg of prednisolone, daily, in 3 doses, with their cessation by gradual reduction of dose). 103 patients (group 3) also received antibacterial therapy in combination with glucocorticoids (20-30 mg of prednisolone, in the morning, in a daily dose every other day, cessation was carried out simultaneously without reducing the dose). RESULTS Results: The study found that the level of cortisol in patients with pulmonary tuberculosis was significantly higher than normal, did not have age and gender dependence, but showed a connection with the severity of clinical forms of tuberculosis, the duration of disease development and the presence of intoxication. It was established that the daily fluctuations of cortisol persist in tuberculosis patients, but its level significantly exceeds the norm, which indicates the functional stressing of the adaptive system. CONCLUSION Conclusions: The article substantiates the homeostatic role of glucocorticoids in the complex treatment of tuberculosis patients when administered in a double physiological dose every other day, taking into account the daily biorhythm of the hypothalamic-pituitary-adrenal axis function.