Early onset of endocrine abnormalities in beta-thalassemia major in a developing country

Endocrine complications in patients with thalassemia major in developing countries may be frequent due to suboptimal iron chelation. Data from developing countries are scant. We prospectively evaluated growth, growth hormone (GH), insulin-like growth factor I, thyroid hormone, cortisol and glucose tolerance in 84 patients over one year. Height standard deviation (SD) score of patients > 8 years (-2.2 +/- 1.5 against National Center for Health Statistics references) was significantly lower than that of normal controls (-1.0 +/- 0.7, p < 0.001). 51% of patients had GH deficiency, 13% hypocortisolism and 7.9% diabetes/impaired glucose tolerance. Ten of 11 adolescents/young adults had hypogonadism. Of 54 preadolescent children who underwent dynamic testing, 18 (33%) had at least one endocrine deficiency other than short stature. We conclude that hypogonadism and hypocortisolism form important causes for morbidity in our thalassemic children. Thalassemic patients in developing countries may be at risk for endocrine deficiencies at younger ages.