Endocrinopathies in transfusion-associated iron overload
Article first published online: 7 JAN 2013
© 2012 Blackwell Publishing Ltd
Volume 78, Issue 2, pages 271–277, February 2013
How to Cite
Kim, M. K., Lee, J. W., Baek, K. H., Song, K. H., Kwon, H. S., Oh, K. W., Jang, E. H., Kang, M. I. and Lee, K. W. (2013), Endocrinopathies in transfusion-associated iron overload. Clinical Endocrinology, 78: 271–277. doi: 10.1111/j.1365-2265.2012.04495.x
- Issue published online: 7 JAN 2013
- Article first published online: 7 JAN 2013
- Accepted manuscript online: 12 JUL 2012 10:44PM EST
- Manuscript Revised: 9 JUL 2012
- Manuscript Accepted: 9 JUL 2012
- Manuscript Revised: 5 JUL 2012
- Manuscript Received: 13 APR 2012
Transfusional iron overload primarily results in reticuloendothelial iron accumulation, which is considered to be less harmful than parenchymal iron accumulation. However, systematic and comprehensive data on endocrine function in transfusion-associated haemochromatosis are limited.
We examined 25 aplastic anaemia patients (11 men and 14 women) diagnosed with transfusion-associated haemochromatosis at a single institution. Pituitary function was determined with a combined pituitary function test. On a different day, a 75-g oral glucose tolerance test was performed. The bone mineral density (BMD) of the lumbar spine and total hip was assessed with dual-energy X-ray absorptiometry.
Twenty-two (88%) of these 25 patients had at least one endocrine abnormality, and 12 had more than one abnormality. The most common pituitary hormonal deficiency involved the pituitary–gonadal axis; 54% of the total subjects had hypogonadotropic hypogonadism. Two patients had an insufficient cortisol response to corticotrophin-releasing hormone stimulation. No patient had a deficiency of growth hormone or thyroid-stimulating hormone. Twelve (48%) had diabetes mellitus, and these patients tended to have higher concentrations of ferritin, alanine aminotransferase and γ-glutamyl transferase. Osteoporosis (T-score <−2·5 SD) was observed in 48% of patients. The reduction in BMD was more pronounced in the lumbar spine than in the total hip. The patients with osteoporosis were accompanied by hypogonadism, which predominantly affected the trabecular bone.
Our observations suggest that endocrinopathies are common in transfusion-associated haemochromatosis.