Central hypothyroidism and hypophysitis during treatment of chronic hepatitis C with pegylated interferon alpha and ribavirin.
Thyroid dysfunction is a known complication of interferon treatment in patients with hepatitis C virus (HCV) infection. Other uncommon endocrine complications have been reported during the treatment of viral hepatitis with IFN-alpha, such as hypopituitarism. A 54-year-old female patient with chronic hepatitis C began treatment with pegylated (PEG)-IFN-alpha 2a 180 mug/week plus ribavirin 1,000 mg/day. At week 20 of treatment, her routine laboratory control showed low levels of thyroid-stimulating hormone (TSH) and free serum thyroxine. This was confirmed at week 24, and other laboratory values showed low levels of adrenocorticotrophic hormone (ACTH). A T1-weighted magnetic resonance imaging scan demonstrated high intensity of the anterior pituitary gland and enhancement after intravenous administration of gadolinium. Hypophysitis with hypothalamic-pituitary dysfunction and secondary or central hypothyroidism was diagnosed on the basis of the clinical features, endocrinological assessment, immunological markers and imaging studies. Twenty-four weeks after stopping treatment, HCV RNA was negative by polymerase chain reaction and alanine aminotransferase values were below the upper limits of normal, and ACTH and thyroid values remained within the reference values. This is the first report of central hypothyroidism and hypophysitis during treatment with PEG-IFN-alpha plus ribavirin, and may be included in the potential list of side effects of the combination treatment.
Ridruejo
Ezequiel
E
Hepatology Section, Department of Medicine, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno CEMIC, Buenos Aires, Argentina. eridruejo@cemic.edu.ar
Christensen
Alejo Flor N
AF
Mando
Oscar G
OG
D000998:Antiviral Agents / Q000009:adverse effects*; D001327:Autoimmune Diseases / Q000139:chemically induced* / Q000175:diagnosis; D003131:Combined Modality Therapy; D005260:Female; D019698:Hepatitis C, Chronic / Q000188:drug therapy*; D006801:Humans; D007037:Hypothyroidism / Q000139:chemically induced* / Q000175:diagnosis / Q000276:immunology; D000077190:Interferon alpha-2; D016898:Interferon-alpha / Q000009:adverse effects*; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D010900:Pituitary Diseases / Q000139:chemically induced* / Q000175:diagnosis; D011994:Recombinant Proteins; D012254:Ribavirin / Q000009:adverse effects; D013963:Thyroid Hormones / Q000097:blood
D000998:Antiviral Agents; D000077190:Interferon alpha-2; D016898:Interferon-alpha; D011994:Recombinant Proteins; D013963:Thyroid Hormones; D012254:Ribavirin