Amenorrhea in beta-homozygous thalassemia major

Hemolytic anemias, and, in particular, beta-homozygous thalassemia, derange all vital organs. A shift of the survival curve to the right has been achieved, thanks to the intensive programs of blood transfusion; iron chelation; infectious control; and, most recently, bone marrow transplantation. Metabolic and endocrine abnormalities do occur, albeit in less severe forms in comparison to available data from 10 to 20 years ago, for example, osteopenia. The most commonly encountered hormonal disorder is the attenuation of gonadal function on a downstream basis, linked to iron deposition in the hypothalamic-pituitary gonadotropin axis. A transition, from low-amplitude endogenous GnRH pulses to apulsatility of LH patterns, precedes the inability of the pituitary gonadotrope to respond to the GnRH decapeptide administered either as an acute bolus injection or in a pulsatile manner for up to 7 days.