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Mineralocorticoid and glucocorticoid status in idiopathic haemochromatosis
C H Walsh1, A L Murphy, S Cunningham
1South Infirmary, Victoria Hospital, Cork, Ireland.
Insights
Idiopathic haemochromatosis does not appear to cause adrenal dysfunction. This study found normal mineralocorticoid and glucocorticoid status in patients with this iron overload disorder, suggesting adrenal issues are rare.
Area of Science:
- Endocrinology
- Hepatology
- Genetics
Background:
- Idiopathic haemochromatosis (IH) is linked to adrenal failure.
- Limited data exists on mineralocorticoid secretion in IH patients.
Purpose of the Study:
- To assess mineralocorticoid and glucocorticoid status in patients with IH.
- To investigate potential adrenal dysfunction in IH.
Main Methods:
- Cross-sectional study of 19 patients with confirmed IH.
- Evaluated pituitary-adrenal axis using Synacthen, metyrapone, and insulin stress tests.
- Measured plasma aldosterone (PA) and renin activity (PRA) basally and upright.
Main Results:
- All pituitary-adrenal axis tests were normal.
- No significant differences in PA, PRA, or PA/PRA ratios were observed between IH patients and controls.
- Upright PA/PRA ratios were also comparable to controls.
Conclusions:
- No abnormalities in the pituitary-adrenal axis or mineralocorticoid status were found in this IH cohort.
- Adrenocortical dysfunction is likely rare in idiopathic haemochromatosis.
- Further research may explore specific genetic or environmental factors.
Objective:
A number of studies have suggested that both primary (Addison's disease) and secondary adrenal failure may be caused by idiopathic haemochromatosis. There is little information on mineralocorticoid secretion. We have assessed the mineralocorticoid and glucocorticoid status of patients with idiopathic haemochromatosis.
Design:
Cross-sectional study.
Patients:
Eighteen males and one female with confirmed idiopathic haemochromatosis were investigated. Seven of the subjects had hepatic cirrhosis and three had hypogonadotrophic hypogonadism.
Measurements:
A short Synacthen (tetracosactrin) test was undertaken in addition to an overnight metyrapone test and an insulin stress test. In addition, plasma aldosterone (PA) and plasma renin activity (PRA) were measured in a group of patients in the basal state and again in the upright position.
Results:
The short Synacthen test, overnight metyrapone test and insulin stress test were normal in all subjects. The PA, PRA, and PA/PRA ratios in the upright position were not significantly different in the patients with idiopathic haemochromatosis compared to control subjects.
Conclusion:
In this patient population, no abnormality of either the pituitary adrenal axis or mineralocorticoid status was detected. Adrenocortical dysfunction is likely to be exceptionally rare in idiopathic haemochromatosis.