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Pituitary function in thalassemic patients and the effect of chelation therapy
S Vannasaeng1, S Fucharoen, P Pootrakul
1Department of Medicine, Siriraj Hospital, Bangkok, Thailand.
Insights
Beta-thalassemia/HbE disease often causes pituitary hormone deficiencies, particularly affecting gonadotropin and prolactin (PRL). Chelation therapy may improve PRL and growth hormone (GH) secretion, but doesn't impact other pituitary hormones.
Area of Science:
- Endocrinology
- Hematology
- Metabolic Disorders
Background:
- Beta-thalassemia/HbE disease is a genetic blood disorder requiring chronic transfusions.
- Iron overload from transfusions can lead to endocrine complications, including pituitary dysfunction.
- Anterior pituitary function is crucial for overall health and is often affected in these patients.
Purpose of the Study:
- To investigate anterior pituitary function in patients with beta-thalassemia/HbE disease.
- To assess the impact of deferoxamine chelation therapy on pituitary function over 18 months.
Main Methods:
- Study included 31 patients with beta-thalassemia/HbE disease, divided into chelation and control groups.
- Pituitary function tests were conducted at baseline and after 18 months.
- Serum ferritin levels were monitored to assess chelation efficacy.
Main Results:
- 22 patients showed decreased pituitary responses, primarily affecting gonadotropin and prolactin (PRL) secretion.
- Deferoxamine therapy significantly reduced serum ferritin levels.
- PRL and growth hormone (GH) responses improved in 3 patients on chelation therapy; other hormone levels remained unchanged.
- The control group showed no significant changes in pituitary function.
Conclusions:
- Gonadotropin and PRL deficiencies are common in beta-thalassemia/HbE patients.
- Eighteen months of deferoxamine chelation therapy can reduce iron burden and potentially preserve or improve PRL and GH secretion.
- Chelation therapy does not appear to benefit other pituitary hormone reserves in this patient group.
Abstract:
This study examined anterior pituitary function and the effect of chelation therapy in 31 patients with beta-thalassemia/HbE disease. Patients were divided into those receiving chelation therapy by deferoxamine and those receiving no such therapy (control group). Pituitary function studies were repeated in both groups 18 months later. The results showed decreased pituitary responses following stimulation in 22 patients. Among these, gonadotropin and PRL responses were most affected. After 18 months, serum ferritin levels had significantly decreased in the deferoxamine group. PRL and GH responses were improved in 3 patients receiving chelation therapy without changes in other hormone responses. In contrast, no changes in pituitary responses were shown in the control group at the end of follow-up. There were 6 drop-outs (4 in the control and 2 in the deferoxamine group) and 3 deaths (2 in the control and 1 in the deferoxamine group) during 18 months. In conclusion, gonadotropin and PRL deficiencies occur most frequently in thalassemic patients. Chelation therapy for 18 months markedly reduced serum ferritin level and might preserve or improve PRL and GH secretions, but seems to have no beneficial effects on other pituitary hormone reserves.