Endocrine manifestations of hepatitis C virus infection.
Chronic infection with hepatitis C virus (HCV) can result in both hepatic and extrahepatic disease and endocrine dysfunction represents an important class of HCV-related extrahepatic disease. The most frequently occurring--and clinically important--of these endocrine disorders are thyroid disease and type 2 diabetes mellitus. In this Review, we evaluate the evidence in support of a link between HCV infection and endocrine-system dysfunction, and discuss potential pathophysiological mechanisms. A meta-analysis of the literature has revealed significant associations between chronic HCV infection, thyroid autoimmunity and hypothyroidism. Furthermore, a high prevalence of thyroid cancer has been reported in HCV-positive patients. Several clinicoepidemiological studies have demonstrated that chronic HCV infection could lead to the development of type 2 diabetes mellitus, possibly as a result of HCV-induced metabolic disturbances. Some researchers have postulated that a type 1 T-helper -cell mediated immune response underpins the association of chronic HCV infection with endocrine disease. Indeed, the available data suggest that a common immunological, type 1 T-helper cell pattern of cytokine expression and activation (via interferon-gamma) could provide the pathophysiological basis for this association. Nonetheless, additional studies will be necessary to elucidate fully all the mechanisms involved in HCV-related endocrine dysfunction.
Antonelli
Alessandro
A
Department of Internal Medicine, University of Pisa, Pisa, Italy. a.antonelli@med.unipi.it
Ferri
Clodoveo
C
Ferrari
Silvia Martina
SM
Colaci
Michele
M
Sansonno
Domenico
D
Fallahi
Poupak
P
D003924:Diabetes Mellitus, Type 2 / Q000209:etiology / Q000473:pathology / Q000821:virology; D004703:Endocrine System / Q000473:pathology* / Q000821:virology*; D016174:Hepacivirus / Q000472:pathogenicity* / Q000502:physiology*; D006801:Humans; D013959:Thyroid Diseases / Q000209:etiology / Q000473:pathology / Q000821:virology; D013964:Thyroid Neoplasms / Q000209:etiology / Q000473:pathology / Q000821:virology