History of myocardial iron loading is a strong risk factor for Diabetes Mellitus and Hypogonadism in adults with β thalassaemia major
Ang AL, Tzoulis P, Prescott E, Davis BA, Barnard M, Shah FT. Eur J Haematol. 2013 Oct 26. doi: 10.1111/ejh.12224. [Epub ahead of print]


Department of Haematology, The Whittington Hospital, Magdala Avenue, London, N19 5NF, UK; Department of Haematology, Singapore General Hospital, Outram Road, Singapore, 169608.


Endocrinopathies are common complications of transfusional haemosiderosis among β Thalassaemia Major (TM) patients. Previous studies had shown associations between some endocrinopathies and iron overload of the myocardium, liver and/or endocrine organs as assessed by MRI techniques. This retrospective analysis of 92 TM patients (median age 36 years) from a tertiary adult thalassaemia unit in UK aimed to determine independent risk factors associated with endocrinopathies among these patients. Unlike previous studies, longitudinal data on routine measurements of iron load (worst myocardial and liver T2* values since 1999, worst LIC by MRI-R2 since 2008 and average 10-year serum ferritin (SF)) up to April 2010 together with demographic features and age of initiating chelation were analysed for associations with endocrinopathies. The most common endocrinopthies in this cohort were hypogonadism (67%) and diabetes mellitus (DM) (41%) and these were independently associated with myocardial T2* < 20 ms (P < 0.001 and P = 0.008 respectively) and increased age (P = 0.002 and P = 0.016 respectively). DM and hypogonadism were independently associated with average SF > 1250 μg/L (P = 0.003) and >2000 μg/L (P = 0.047) respectively. DM was also associated with initial detection of abnormal myocardial T2* at an older age (30 years vs 24 years, P = 0.039). An abnormal myocardial T2* may therefore portend the development of diabetes mellitus and hypogonadism in patients with TM.