Pituitary Iron and Volume Imaging in Healthy Controls

Noetzli, Leila; Panigrahy, Ashok; Hyderi, Aleya; Dongelyan, Ani; Coates, Thomas D.; Wood, John C.

doi:10.3174/ajnr.a2788

Cited by 21 publications

(23 citation statements)

References 26 publications

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“…32 With appropriate distraction techniques (such as video goggles), children as young as 4 or 5 years of age may be studied without sedation. 37 Cardiac iron assessments require more patient cooperation and may be safely deferred until the patient is able to cooperate (6-10 years of age) in standard-risk patients. 32 However, Blackfan-Diamond patients should undergo cardiac T2* assessments after 2 years of chronic transfusion therapy even if anesthesia is required.…”

Section: Practical Monitoringmentioning

confidence: 99%

“…Pituitary volume and pituitary iron both change with age and need to be converted to Z-scores using nomograms. 37 Both heavy iron deposition (Z-scores Ͼ5) and volume loss (Z-scores ϽϪ2.5) are associated with hypogonadism. However, there is a broad range of moderate iron deposition (2 Ͻ Z Ͻ 5) and 50% of patients with heavy iron deposition are symptom free, similar to the relationships observed in the heart.…”

Section: Iron In Other Organsmentioning

confidence: 99%

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Guidelines for quantifying iron overload

Wood

2014

Hematology

112

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Both primary and secondary iron overload are increasingly prevalent in the United States because of immigration from the Far East, increasing transfusion therapy in sickle cell disease, and improved survivorship of hematologic malignancies. This chapter describes the use of historical data, serological measures, and MRI to estimate somatic iron burden. Before chelation therapy, transfusional volume is an accurate method for estimating liver iron burden, whereas transferrin saturation reflects the risk of extrahepatic iron deposition. In chronically transfused patients, trends in serum ferritin are helpful, inexpensive guides to relative changes in somatic iron stores. However, intersubject variability is quite high and ferritin values may change disparately from trends in total body iron load over periods of several years. Liver biopsy was once used to anchor trends in serum ferritin, but it is invasive and plagued by sampling variability. As a result, we recommend annual liver iron concentration measurements by MRI for all patients on chronic transfusion therapy. Furthermore, it is important to measure cardiac T2* by MRI every 6-24 months depending on the clinical risk of cardiac iron deposition. Recent validation data for pancreas and pituitary iron assessments are also presented, but further confirmatory data are suggested before these techniques can be recommended for routine clinical use.

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Section: Practical Monitoringmentioning

confidence: 99%

Section: Iron In Other Organsmentioning

confidence: 99%

Guidelines for quantifying iron overload

Wood

2014

Hematology

112

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“…Furthermore, cardiac iron content predicts development of clinical heart failure [139]. Pancreatic as well as pituitary iron quantification can also be accomplished non-invasively by MRI, and has been shown to predict glucose tolerance and pituitary volume and function [134, 140–142]. MRI quantification of liver iron as a measure of total body iron burden and cardiac iron are now considered standard state-of-the-art measures at most major thalassemia centers and are credited in part for the 70% reduction in deaths from cardiac iron overload in the past decade [2].…”

Section: Transfusion-related Iron Overloadmentioning

confidence: 99%

Physiology and pathophysiology of iron in hemoglobin-associated diseases

Coates

2014

Free Radical Biology and Medicine

153

118

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Iron overload and iron toxicity, whether because of increased absorption or iron loading from repeated transfusions, can be major causes of morbidity and mortality in a number of chronic anemias. Significant advances have been made in our understanding of iron homeostasis over the past decade. At the same time, advances in magnetic resonance imaging have allowed clinicians to monitor and quantify iron concentrations non-invasively in specific organs. Furthermore, effective iron chelators are now available, including preparations that can be taken orally. This has resulted in substantial improvement in mortality and morbidity for patients with severe chronic iron overload. This paper reviews the key points of iron homeostasis and attempts to place clinical observations in patients with transfusional iron overload in context with the current understanding of iron homeostasis in humans.

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“…Since the pituitary resides in a magnetically inhomogenous environment (in the sella tursica), R2 imaging, rather than R2* imaging is indicated. Imaging protocols for pituitary R2 and pituitary volume assessment are well established[60], and age and sex specific normative values have been published. A Z vol value < −2 indicates gland shrinkage below the 2.5 th percentile and a Z R2 value > 2 indicates iron accumulation > 97.5 th percentile.…”

Section: Measurement Of Non-hepatic Iron Storesmentioning

confidence: 99%

“…Plot of pituitary size (Z-score) versus pituitary iron[58, 60]. No pituitary dysfunction was observed when size and iron Z-scores were normal (green) or even when pituitary iron was moderately elevated (Z score 2 to 5, yellow zone)[58].…”

Section: Figurementioning

confidence: 99%

Use of Magnetic Resonance Imaging to Monitor Iron Overload

Wood

2014

Hematology/Oncology Clinics of North America

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SYNOPSIS Treatment of iron overload requires robust estimates of total body iron burden and its response to iron chelation therapy. Compliance with chelation therapy varies considerably among patients and individual reporting is notoriously unreliable. Even with perfect compliance, intersubject variability in chelator effectiveness is extremely high, necessitating reliable iron estimates to guide dose titration. In addition, each chelator has a unique profile with respect to clearing iron stores from different organs. This chapter will present the tools available to clinicians monitoring their patients, focusing on non-invasive magnetic resonance imaging methods because they have become the de-facto standard of care.

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Pituitary Iron and Volume Imaging in Healthy Controls

Cited by 21 publications

References 26 publications

Guidelines for quantifying iron overload

Guidelines for quantifying iron overload

Physiology and pathophysiology of iron in hemoglobin-associated diseases

Use of Magnetic Resonance Imaging to Monitor Iron Overload

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