Evaluation of endocrine complications in patients with thalassemia major

Abstract

Aim: Multiple blood transfusions in beta thalassemia patients causes iron overload in various tissues including endocrine glands thereby leading to multiple endocrine dysfunction. The aim of this study was to determine the endocrine complications seen in beta thalassemia patients followed-up in outpatient clinics of Pediatric Hematology Division of Uludag University Faculty of Medicine.Materials and Methods: The files of patients with thalassemia major followed-up in outpatient clinics of Pediatric Hematology Division of Uludag University Faculty of Medicine from January 1976 to August 2008 were retrospectively evaluated for endocrine disorders. All patients had a detailed physical examination including palpation of thyroid gland and pubertal staging. Endocrine evaluation was performed in the Division of Pediatric Endocrinology.Results: A total of 44 [20 female (45.5%); 24 male (54.5%); and mean chronological age 13.54 +/- 7.32 (2.75-35.2) years] patients were evaluated. The ratios of patients with endocrine dysfunction were 27.2 % and 90.9%, respectively, when we exclude or include those with osteoporosis/osteopenia or growth failure other than growth hormone deficiency. Of all patients, 27 (61.3%) had osteoporosis, 17 (38.6%) had growth retardation, 11 (25%) had osteopenia, 6 (13.6%) had hypogonadism, 3 (6.8%) had hypothyroidism, 2 (4.5%) had hypoparathyroidism, 1 (2.3) had growth hormone deficiency, and 1 (2.3) had type 1 diabetes mellitus. Mean ferritin levels and monthly transfusion numbers were 1976.15 +/- 1494.75 ng/ml and 1.46 +/- 0.34, respectively. There were no significant association between ferritin levels, monthly transfusion needs, and endocrine dysfunctions studied. Endocrine dysfunctions did not differ significantly amongst those having different chelating agents. The ratio of patients with growth retardations in 10 to 19-age-group was significantly higher than those in 0 to 9-age-group (30.6% vs 8.3%; p=0.049).Conclusion: Patients with thalassemia major are under increased risk of various endocrine dysfunction. Bone health is significantly compromised. Those younger than 10 years should be closely followed for especially growth retardation and osteoporosis/osteopenia and those who are 10 years of age or older should be followed for all endocrine pathologies, especially for hypogonadism, growth retardation, and osteoporosis.