Hypoparathyroidism in transfusion-dependent patients with β-thalassemia

Abstract

Hypoparathyroidism is thought to be a rare consequence of iron overload seen in beta-thalassemic transfused patients. This study was conducted to determine the prevalence of hypoparathyroidism in a large number of beta-thalassemic patients, and its potential correlation with the presence of other endocrinopathies caused by iron overload. Serum and urine biochemical parameters were measured in 243 thalassemic patients (136 females and 107 males) in order to determine the prevalence of hypoparathyroidism and evaluate bone turnover. The patients were divided into two groups according to the presence of hypoparathyroidism. We compared the prevalence of other endocrinopathies and disease complications in the two groups. Hypoparathyroidism was detected in 13.5% of the patients (33 subjects; 17 males and 16 females). Serum-intact parathyroid hormone, and total and ionized calcium were significantly lower, while phosphorus was significantly higher in thalassemic patients with hypoparathyroidism. The reduction in BMD was more prominent in normal thalassemic patients (Z score = -2.246 +/- 0.97) compared with those with hypoparathyroidism (Z score = -1.975 +/- 0.89), although the difference was not statistically significant. Disturbed glucose metabolism was more common in patients with hypoparathyroidism (P < 0.05). In addition, heart dysfunction was statistically more frequent in this group (odds ratio = 2.51, P < 0.05). Hypoparathyroidism is a not infrequently observed complication in thalassemic patients. Since the concentration of ferritin is not a valuable tool in the prediction of the development of hypoparathyroidism, parathyroid function should be tested periodically, particularly when other iron overload-associated complications occur.

A Review of Endocrine Disorders in Thalassaemia

“…Iron toxicity may cause overt hypoparathyroidism in 3% -4% of thalassaemia patients whereas preclinical hypoparathyroidism was recently reported to occur in close to 100% of thalassaemic patients [81]. Angelopoulos et al [82] in their study of transfusion dependant patients with β thalassaemia have demonstrated hypoparathyroidism in 13.5% subjects with significant low levels of intact parathyroid hormone and total and ionized calcium. Similarly Aleem et al [83] have shown that 20% of their patients had hypoparathyroidism which was much higher compared to the multicentre study in Italy [35] involving 25 centres which showed the prevalence to be 3.6%.…”

Prevalence of Hypoparathyroidism (HPT) in Beta Thalassemia Major

“…The cause of such alterations in ferritin values may be the regular blood transfusions. Another study was conducted in Greece to determine the prevalence of HPT in a large number of beta thalassemic patients, and its potential correlation with the presence of other endocrinopathies caused by iron overload [21]. Serum and urine biochemical parameters were measured in 243 thalassemic patients (136 females and 107 males) in order to determine the prevalence of hypothyroidism and evaluate bone turnover.…”

Latent Hypoparathyroidism in an Osteoporotic Patient with Multiple Endocrinopathies and Secondary Hemochromatosis due to Multiple Blood Transfusions, Unmasked by Alendronate and Glucocorticoid at Adrenal Crisis

“…In (3)(4)(5)(6)(7)(8)(9). In the present patient with aplastic anemia who had received multiple blood transfusions since the age of 3 years, hemosiderin deposits were demonstrated in the liver (Fig.…”

“…Subclinical hypoparathyroidism is frequently associated with primary and secondary hemochromatosis (1,2) and several symptomatic hypocalcemic cases with beta-thalassemia, Blackfan-Diamond anemia, and aplastic anemia due to multiple blood transfusions have been reported (3)(4)(5)(6)(7)(8)(9).…”