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Ultrasonography of the pancreas, as a function index, in children with beta-thalassemia
M Theochari1, D Ioannidou, H Nounopoulos
1Department of Pediatrics, Faculty of Nursing, University of Athens, P. & A. Kyriakou Children's Hospital, Greece.
Insights
Increased pancreatic echogenicity in beta-thalassemia patients is linked to pancreatic dysfunction. This ultrasound finding may serve as an early indicator for diabetes mellitus risk.
Area of Science:
- Pediatric Endocrinology
- Medical Imaging
- Hematology
Background:
- Beta-thalassemia is associated with hemosiderosis, often leading to increased pancreatic echogenicity.
- Pancreatic dysfunction, both endocrine and exocrine, is a potential complication in these patients.
Purpose of the Study:
- To investigate the association between increased pancreatic echogenicity and pancreatic dysfunction in children and adolescents with beta-thalassemia.
- To determine if ultrasound-detected pancreatic echogenicity can serve as an early marker for pancreatic dysfunction.
Main Methods:
- Ultrasound examination of the pancreas in 34 pediatric beta-thalassemia patients.
- Assessment of endocrine function via Oral Glucose Tolerance Test (OGTT) with simultaneous insulin measurement.
- Assessment of exocrine function through serum trypsin level measurement.
Main Results:
- 76.5% of patients showed increased pancreatic echogenicity.
- Patients with increased echogenicity had significantly higher glucose levels during OGTT (p<0.05).
- Insulin levels were significantly affected at 30, 60, and 90 minutes in patients with increased echogenicity (p<0.05).
- Abnormal trypsin levels were more frequent in patients with increased echogenicity, though not statistically significant.
Conclusions:
- Increased pancreatic echogenicity in beta-thalassemia is significantly associated with impaired glucose metabolism and altered insulin secretion.
- Ultrasound assessment of pancreatic echogenicity may be a valuable, non-invasive early indicator of pancreatic dysfunction and future diabetes mellitus risk in this population.
Abstract:
Increased echogenicity of the pancreas, due to hemosiderosis, is a frequent laboratory finding in children and adolescents with beta-thalassemia. The aim of this study was to investigate whether increased echogenicity of the pancreas is associated with dysfunction. The ultrasonic image of the pancreas was examined in 34 children aged 12+/-3.8 years old and was compared to the endocrine and exocrine functioning of the gland. Oral glucose tolerance test (OGTT) was performed with simultaneous measurement of insulin and serum trypsin. Twenty-six of the 34 patients (76.5%) presented increased echogenicity, while 8 (23.5%) had a normal ultrasonic pancreatic image. 77% of the patients with increased echogenicity had abnormal OGTT, 46%, with subnormal or increased insulin values, and 32.5% manifested low levels of trypsin. Among the patients with normal ultrasound, 25% had abnormal OGTT and 37.5% abnormal insulin values. Statistical analysis with Student's t-test revealed that patients with increased echogenicity had significantly higher glucose values on OGTT at 60: 7.6 +/- 1.8 mmol/l (137.3 +/- 33.7 mg/dl) as compared to the patients with normal ultrasound: 6.1 +/- 1.2 mmol/l (110.75 +/- 21.72 mg/dl) (p<0.05). Insulin values were significantly affected at 30, 60, and 90 min: 570+/-301, 332+/-156, 294+/-158 pmol/l (79.54 +/- 42, 46.4 +/- 21.8, 41.04 +/- 22 mU/l) respectively in patients with increased echogenicity in comparison to those with normal ultrasonographic image of the gland: 301 +/- 170, 192 +/- 52, 135 +/- 63 pmol/l (42 +/- 23.7, 26.85 +/- 7.36, 18.9 +/- 8.8 mU/l) (p<0.05). No statistical significance was observed between the two groups regarding trypsin levels, even though abnormal values were observed in more children with increased echogenicity than in patients with a normal ultrasound. The above findings confirm that increased echogenicity of the pancreas is associated with disturbance of its function. This simple imaging method could be used as a rough early index of detection of an increased risk for developing diabetes mellitus in patients with beta-thalassemia.
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