Research Article

Parathyroid Functions in Thalassemia Major Patients

Ayfer Gozu Pirinccioglu*, Deniz Gokalp and Murat Soker

Published: 08/29/2017 | Volume 1 - Issue 1 | Pages: 015-019

Abstract

Background: Hypoparathyroidism is well known to occur in thalassemia major patients, but it is thought to be uncommon and its incidence is considered to be decreasing with improvements in chelation therapy. The objective of this study was to assess the prevalence of parathyroid dysfunction in the first decade of life of the patients with thalassemia major.

Patients and Methods: Ninety children with beta-thalassemia major (55 males and 35 females) with a mean age of 7.17±3.78 years (1-13 years) and age and sex matched control group of 60 healthy children (36 males and 24 females) with a mean age 6.98±3.66 years (1-13) years. Serum parathyroid hormone (PTH), serum total Calcium (Ca), serum phosphorus (P), serum alkaline phosphatase (ALP), serum 25-hydroxyvitamin D (25-OHD) and serum ferritin levels were measured.

Result: PTH levels were higher than normal range in 23 (25.6%) patients with a mean value of 75.2±31.3 µg/mL compared to those having normal range level (35.3±15.2 µg/mL). Ca levels were found low in 11 patients (12.2%), and P levels were found high in 2 (2.22%) and low in 4 (4.44%) patients while high ALP levels were found in 6 (6.67%) patients. 25-OHD levels were low in all patients with a mean value of 24.95±5.82.

Conclusion: Reports in the literature indicate that parathyroid dysfunction due to iron overload generally occurs in 2nd or 3rd decade of patients with thalassemia major. However, our study shows that PTH due to iron overload may develop in a significant number of thalassemia major patients, therefore, all thalassemics should be carefully watched for endocrine organ function such as hyperparathyroidism might occur even in the first decade of the patients with thalassemia major.

Read Full Article HTML DOI: 10.29328/journal.hcem.1001003 Cite this Article

References

  1. Cooley TB, Lee P. A series of cases of splenomegaly in children with anemia and peculiar changes. Trans Am Pediatr Soc. 1925; 37: 29-30.
  2. Saka N, Sukur M, Bundak R, Anak S, Neyzi O, et al. Growth and puberty in thalassemia major. J Pediatr Endocrinol Metab. 1995; 8: 181-186. Ref.: https://goo.gl/CfD5Da
  3. Modell B, Letsky EA, Flynn DM, Peto R, Weatherall DJ. Survival and desferrioxamine in thalassemia major. BMJ. 1982; 284: 1081-1084. Ref.: https://goo.gl/c1pWcH
  4. Al-Elq AH, Al-Seed HH. Endocrinopathies in patients with thalassemias. Saudi Med J. 2004; 25: 1347-1351. Ref.: https://goo.gl/F2LtFi
  5. Vullo C, De Sanctis V, Katz M, Wonke B, Hoffbrand AV, et al. Endocrine abnormalities in thalassemia. Ann NY Acad Sci. 1990; 612: 293-310. Ref.: https://goo.gl/2PgmVY
  6. Pirinccioglu AG, Akpolat V, Gökalp D, Koksal O, Haspolat K, et al. Bone mineral density in children with beta-thalassemia major in Diyarbakir. Bone. 2011; 49: 819-823. Ref.: https://goo.gl/b7VXj5
  7. Pirinccioglu AG, Deniz T, Gokalp D, Beyazit N, Haspolat K, et al. Assessment of Thyroid Function in Children Aged 1-13 Years with Beta-Thalassemia Major. Iranian J Pediatr. 2011; 21: 77-82. Ref.: https://goo.gl/y3pJp4
  8. Perignon F, Brauner R, Souberbielle JC, de-Montalembert M, Girot R. Growth and endocrine function in major thalassemia. Arch Fr Pediatr. 1993; 50: 657-663. Ref.: https://goo.gl/ezSvnZ
  9. Multicenter study of prevalence of endocrine complications in thalassaemia major. Italian Working Group On Endocrine Complications in Non-Endocrine Diseases. Clin Endocrinol (Oxf). 1994; 42: 581-586. Ref.: https://goo.gl/hWWf9D
  10. Güler E, Patıroğlu T, Çaksen H, Özdemir MA, Kurtoğlu S, et al. Talasemi Majörlü Vakalarda Endokrin Komplikasyonların Değerlendirilmesi. Turkish. 199; 34: 174-781. Ref.: https://goo.gl/jbXcZM
  11. Risdon RA, Flynn DM, Barry M. The relation between liver iron concentration and liver damage in transfusional iron overload in thalassaemia and the effect of chelation therapy. Gut 1973; 14: 421. Ref.: https://goo.gl/8nq4JW
  12. Hershko C, Weatherall DJ. Iron-chelating therapy. Crit Rev Clin Lab Sci 1988; 26: 303-345. Ref.: https://goo.gl/hoqTCH
  13. Hershko C, Konijn AM, Link G. Iron chelators for thalassaemia. Br J Haematol 1998; 101: 399-406. https://goo.gl/ySg6hS
  14. De Vernejoul MC, Girot K, Gueris J, Cancela L, Bang S,et al. Calcium phosphate metabolism and bone disease in patients with homozygous thalassaemia. J Clin Endocrinol Metab.1982; 54: 276-281. Ref.: https://goo.gl/o2ae6d
  15. Peacey SR, Routine biochemistry in suspected vitamin D deficiency. J R Soc Med. 2004; 97: 322-325. Ref.: https://goo.gl/xLjUeY
  16. Gutteridge JM, Halliwell B. Iron toxicity and oxygen radicals. In: Hershko C, editor. Iron chelating therapy. London: Baillière Tindall, 1989; 2: 195-256. Ref.: https://goo.gl/h7fbJN
  17. Iancu T. Ultrastructural pathology of iron overload with special reference to endocrine glands. In: Pintor C, Corda R, De-Sanctis V, editors. Workshop on endocrine problems in thalassemia. Venezia: San Marco Scientific Publications. 1990: 19-28.