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Overlooked complication of Cushing's syndrome: Reactivation of hepatitis B

Tugba Barlas1, Mehmet Muhittin Yalcin1, Hasan Selcuk Ozger2

  • 1Department of Endocrinology and Metabolism, Gazi University, Ankara, Turkey.

Clinical Endocrinology
|November 28, 2022
PubMed

Insights

Patients with Cushing's syndrome (CS) have a significant prevalence of hepatitis B virus (HBV) infection. Antiviral prophylaxis should be considered for these patients due to the risk of HBV reactivation.

Area of Science:

  • Endocrinology
  • Hepatology
  • Immunology

Background:

  • Hepatitis B virus (HBV) reactivation is a risk in immunosuppressed individuals.
  • Current guidelines address exogenous corticosteroids but not endogenous hypercortisolemia in Cushing's syndrome (CS).

Purpose of the Study:

  • To determine the prevalence of HBV infection in CS patients.
  • To evaluate the need for antiviral prophylaxis in CS patients.

Main Methods:

  • Retrospective analysis of 72 CS patients screened for HBV (2016-2021).
  • Patients categorized by cortisol burden: overt CS, mild autonomous cortisol secretion (MACS), and remission.
  • Analysis of HBV serology and clinical outcomes over time.

Main Results:

  • 19.4% of CS patients were anti-HBc IgG positive; 4 had chronic HBV, 15 had isolated anti-HBc IgG.
  • 5.5% of patients were HBsAg positive, indicating inactive chronic HBV.
  • Two patients experienced HBV reactivation, and one had an HBV flare.

Conclusions:

  • CS patients exhibit a notable prevalence of HBV infection.
  • Long-term hypercortisolemia in CS necessitates a consensus on HBV screening, follow-up, and prophylaxis.
  • Prophylaxis is particularly important in regions with high HBV prevalence.
Abstract

Keywords:
Cushing's syndromehepatitis B flarehepatitis B virusreactivation

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