Central hypothyroidism and hypophysitis during treatment of chronic hepatitis C with pegylated interferon alpha and ribavirin
Central hypothyroidism and hypophysitis during treatment of chronic hepatitis C with pegylated interferon alpha and ribavirin
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DOI：
10.1097/00042737-200606000-00019
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发表时间：
2006-06-01
影响因子：
2.1
通讯作者：
Mando, Oscar G.
中科院分区：
文献类型：
--
作者：
Ridruejo, Ezequiel;Christensen, Alejo Florin;Mando, Oscar G.
甲状腺功能障碍是干扰素治疗丙型肝炎病毒（HCV）感染患者的已知并发症。在使用IFN-α治疗病毒性肝炎期间，还报告了其他不常见的内分泌并发症，如垂体功能减退症。一名54岁的女性慢性丙型肝炎患者开始用聚乙二醇化（PEG）-IFN-α 2a 180 μ g/周加利巴韦林1000 mg/天治疗。在治疗第20周时，她的常规实验室控制显示促甲状腺激素（TSH）和游离血清甲状腺素水平较低。这在第24周得到证实，其他实验室检查值显示促肾上腺皮质激素（ACTH）水平较低。T1加权磁共振成像扫描显示垂体前叶高信号，静脉注射钆后增强。根据临床表现、内分泌学检查、免疫学指标和影像学检查，诊断为垂体炎伴下丘脑-垂体功能障碍和继发性或中枢性甲状腺功能减退。停止治疗后24周，聚合酶链反应检测HCV RNA为阴性，丙氨酸氨基转移酶值低于正常上限，ACTH和甲状腺值保持在参考值范围内。这是第一次报告的中枢性甲状腺功能减退症和垂体炎治疗期间与PEG-IFN-α加利巴韦林，并可能被列入潜在的联合治疗的副作用列表。
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 mu g/week plus ribavirin 1000 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.