Serum ferritin levels and endocrinopathy in medically treated patients with β thalassemia major

The association between iron overload indices and pathology of the heart and liver in transfusion-dependent patients with beta thalassemia major (TM) has been extensively studied. Nonetheless, data on endocrine disease remains limited. This was a cross-sectional study of 382 TM patients treated with regular transfusions and desferrioxamine at the Thalassemia Center in Dubai, UAE. Retrieved data included demographics, splenectomy status, steady-state serum ferritin levels, and the presence of endocrinopathies (diabetes mellitus, hypothyroidism, hypoparathyroidism, and hypogonadism). Multivariate logistic regression analyses were used to determine which variables were independently associated with the occurrence of each endocrinopathy. The mean age of patients was 15.4 +/- 7.6 years, with an equal sex distribution. The mean serum ferritin level was 2597.2 +/- 1976.8 mu g/l. The frequencies of specific endocrinopathies were diabetes mellitus (10.5%), hypothyroidism (6.3%), hypoparathyroidism (10.5%), and hypogonadism (25.9%). On multivariate logistic regression analysis, patients with a serum ferritin level > 2,500 mu g/l, but not > 1,000-2,500 mu g/l, were 3.53 times (95% CI 1.09-11.40) more likely to have diabetes mellitus, 3.25 times (95% CI 1.07-10.90) more likely to have hypothyroidism, 3.27 times (95% CI 1.27-8.39) more likely to have hypoparathyroidism, and 2.75 times (95% CI 1.38-5.49) more likely to have hypogonadism compared to patients with a serum ferritin level a parts per thousand currency sign1,000 mu g/l. However, splenectomized patients with serum ferritin levels a parts per thousand currency sign2,500 mu g/l had comparably high rates of all endocrinopathies as patients with serum ferritin levels > 2,500 mu g/l. Endocrinopathy is common in TM patients treated with desferrioxamine therapy, especially in patients with serum ferritin levels > 2,500 mu g/l or those splenectomized.