Pancreatic MR imaging and endocrine complications in patients with beta-thalassemia: a single-center experience

Abstract

Iron deposition in various organs can cause endocrine complications in patients with transfusiondependent beta-thalassemia. The aim was to investigate the relationship between endocrine complications and pancreatic iron overload using magnetic resonance imaging (MRI). Forty patients with transfusion-dependent thalassemia (TDT) were enrolled in the study. The magnetic resonance imagings of the patients were performed using a 1.5 Tesla Philips MRI scanner. Two out of three patients had at least one clinical endocrine complication. The rate of iron deposition was 62.5% in liver, and 45% in pancreas tissue, and was 12.5% in heart tissue. Pancreatic T2* and hepatic T2* values were signi cantly positively correlated (p = 0.006). Pancreatic T2* and ferritin were signi cantly negatively correlated (p = 0.03). Cardiac T2* values were negatively correlated with fasting blood glucose (p = 0.03). Patients with short stature had signi cantly higher cardiac iron burden (22.3 vs. 36.6 T2*ms; p00.01) and patients with hypothyroidism had higher liver iron concentrations (9.9 vs. 6.4 LIC mg/g; p = 0.05). The ferritin level of 841 ng/mL, and liver iron concentration (LIC) value of 8.7 mg/g were detected as the threshold level for severe pancreatic iron burden (AUC 70%, p:0.04, AUC 80%, p = 0.002, respectively). Moreover, males were found to have decreased pancreas T2* values compared with the values in females (T2* 19.3 vs. 29.9, p = 0.05). Patients with higher ferritin levels over than 840 ng/mL should be closely monitored for pancreatic iron deposition, and patients with endocrine complications should be assessed in terms of cardiac iron burden.

Association of hepatic/pancreatic iron overload evaluated by quantitative T2* MRI with bone mineral density and trabecular bone score

“…Additionally, our study, in parallel with previous reports [ 28 – 31 ], indicated that liver T2*-value was significantly correlated with pancreatic T2*-value, serum ferritin and serum iron and pancreatic T2*-value showed significant negative correlation with serum ferritin, whereas others have shown no correlation between hepatic and pancreatic iron [ 32 , 33 ]. These controversial results may be attributed to differences in the type of disease, number of subjects, and management.…”

New Entity—Thalassemic Endocrine Disease: Major Beta-Thalassemia and Endocrine Involvement

“…As mentioned, musculoskeletal evaluation is important in children and adults, yet there are some other particular aspects [ 110 ]. Pituitary hemosiderosis in children with BTH might predict delayed puberty, short stature and central hypothyroidism [ 22 , 111 , 112 , 113 ]. Interestingly, brain MRI data showed conflicting results regarding IO; noting that the pituitary gland is particularly sensitive to iron deposits following the trend of the other endocrine glands [ 112 ].…”

“…An MRI-based study on 40 patients with transfusion-dependent TH identified that iron deposits are positive in 62.5% of persons in the liver, 45% in the pancreas, and 12.5% in the heart. Three out of fifty patients had at least one ED [ 113 ]. The cardiac T2* sequence evaluating iron upload negatively correlates with fasting glycaemia ( p = 0.03); subjects with short stature had increased cardiac iron overload ( p = 0.01).…”

“…The cardiac T2* sequence evaluating iron upload negatively correlates with fasting glycaemia ( p = 0.03); subjects with short stature had increased cardiac iron overload ( p = 0.01). Those with hypothyroidism had higher hepatic overload ( p = 0.05), and females displayed increased pancreatic iron burden T2* sequence when compared to males [ 113 ].…”

Glucose Homeostasis and Αssessment of Β-Cell Function by 3-Hour Oral Glucose Tolerance (Ogtt) in Patients With Β-Thalassemia Major With Serum Ferritin Below 1,000 Ng/Dl: Results From a Single Icet-a Centre

“…Later, additional methods for monitoring ICT were developed, namely magnetic resonance imaging (MRI) for assessment of liver iron concentration (LIC) and T2* for cardiac iron load for monitoring chelator efficacy or stratifying end-organ risk. 4 Each method has pros and cons to quantifying and monitoring iron burden. When intensification of chelation is required for patients with a very high iron burden, combination therapy is used.…”