Endocrine Abstracts

Introduction: Thalassemia manifests clinically as anemia requiring life-long blood transfusions and the chronic iron deposition . Iron overload can lead to decreased functioning of the respective systems. Thalassemia-associated osteoporosis constitutes a majorproblem. Weinvestigated the bone mineral density scores of the thalassemic patients and correlated the scores of themwith some parameters including the transfusion frequency, levels of ferritin and pituitary hormones.

Subjects-materials: We recruited 54 thalassemic patients who were under follow-up in our hospital.26 of them were male, 28 were female. The mean of their age was 27.0 ± 8.4 years, body weight 52.1 ± 8.6 kg, transfusion frequency every 3.07 ± 0.71 weeks, calcium (Ca) corrected for albumin 8.9 ± 0.42 mg/dl, 25-0 h-vitamin D 321.9 ± 10.5 ng/ml, total bilirubin (tot bil) 3.00 ± 1.8 mg/dl, magnesium (Mg) 2.00 ± 0.1 mg/dl, free triiodothyronine (f T3): 3.13 (OR:0.41, P = 0.003) 0.62 ng/dl, prolactin 13,6 ± 6.0 ng/ml, cortisol 11.2 ± 2.9 mg/dl, Luteinizing hormone (LH): 2.5 ± 1.7 IU/l, alkalen phosphatase 91.6 ± 35.7 U/l, hemoglobin 9.3 ± 0.7 g/dl, ferritin 1918.8 ± 2188.3 ng/ml, mean corpuscular volume(MCV): 80.4 ± 4.4 femtoliter/cell (fL), mean platelet volume (MPV) 7.39 ± 1.88 fL, low density lipoprotein (LDL) 50.4 ± 27.8mg/dl, high density lipoprotein (HDL):32.1 ± 10.7 mg/dl, total cholesterol :107.9 ± 33.5 mg/dl, Lumbar spine1-4 (L1-L4)T score −2,1 ± 1.2, femoral total T score -0.7 ± 1.4, femoral neck T score -0.7 ± 1.5. When correlation analysis was attempted L1-L4 T score was correlated with Mg level [Odd’s ratio (OR): 0.35 (P = 0.021)], cortisol level (OR: −0.74, P = 0.00), ferritin (OR: −0.38, P = 0.007) and body weight (OR: 0.73, P =0.036). Femoral total T score was correlated with tot.bil. (OR: 0.41, P = 0.003), MCV:f T3 (OR: 0.77, P =0.014), LH (OR: 0.73, P = 0.033), LDL (OR: −0.42, P = 0.003), total cholesterol (OR: −0.44, P = 0.002), MCV (OR: −0.38, P = 0.008). Seven (25%) female described amenorrhea,while one male (3.8%) had azospermia, one had decreased (3.8%) and two (7.7%) had increased total testosterone levels. Three (5.5%) patients had low IGF1 levels whose growth hormone levels showed normality after insulin tolerance test. Two patients experienced lumbar vertebralheight loss (3.7%) while one developed (1.8%) clavicle fracture. One patient (1.8%) had hypothyroidism under hormonal treatment while two (3.7%) had type1 diabetes mellitus.

Conclusion: The frequent endocrine complications reported in the literature in thalassemia are growth retardation, delayed puberty, hypogonadism, diabetes, impaired thyroid functions, and dyslipidemias. Early recognition and treatment of endocrine complications is important. A decrease in bone mass alsocan occur due to increased bone resorption or decreased bone formation which can lead to osteopenia/osteoporosis in thalassemia . The bone mass would be affected from several types of variables differing for separate parts of the skeleton thatconstitutesof L1-L4 vertebra and femur in our study . Transfusionnormalizing hemoglobin levels, iron chelation, and adequate hormonal,Vitamin D and calcium replacement therapy would reduce progressive bone disease.