Factors associated with insulin-like growth factor-1 in children with thalassemia major

Abstract

Background Septic shock remains a major cause of mortality Background Insulin-like growth factor-1 (IGF-1) deficiency is the major cause of growth disorders and delayed puberty in children with thalassemia. Hence, identifying factors contributing to IGF-1 deficiency in thalassemia is of importance.Objectives To evaluate the correlation between IGF-1 level and nutritional status, ferritin, pre-transfusion hemoglobin, thyroid, as well as alanine transaminase levels. MethodsWe conducted a study in children aged 2 to 18 years with thalassemia major who visited outpatient clinics at two hospitals in Indonesia, Dr. Sardjito Hospital, Yogyakarta and Dr. Moewardi Hospital, Surakarta, Central Java, from July to December 2015. Clinical, laboratory, and demographic data were reviewed from medical records. IGF-1 levels were measured using an immunochemiluminiscent method.Results A total of 48 children were recruited into the study. Subjects mean IGF-1 level was 109.28 (SD 90.26) ng/mL. Seventy-five percent of the children had IGF-1 level < -2SD. Subjects mean ferritin, pre-transfusion hemoglobin and ALT levels were 3.568 (SD 2131.31) ng/mL; 7.97 (SD 0.85) g/dL and 49.7 (SD 43.1), respectively. Most of the children (91.7%) was eutyroid, with a mean of TSH and FT4 level was 2.7 (SD 1.5) nmol/L and 12.3 (SD 7.1) μIU/ml, respectively. Ferritin level had no significant correlation with IGF-1 level (r=-0.794; P=0.431). However, a strong, positive correlation was documented between pre-transfusion hemoglobin level and IGF-1 level (r=2.380; P=0.022). Multivariate linear regression analysis revealed that factors with significant correlations to IGF-1 level were pre-transfusion hemoglobin level <8 g/dL (β=-0.090; 95%CI -0.002 to 0.182; P=0.056) and undernutrition (β=0.077; 95%CI 0.045 to 0.109; P<0.001). ConclusionLow pre-transfusion hemoglobin level and undernutrition are significantly correlated to low IGF-1 level in children with thalassemia major. [Paediatr Indones. 2019;59:72-8; doi: http://dx.

Assessment of growth-related hormones in patients with hereditary hemoglobinopathies

“…Growth failure in SCD is also believed to be induced by higher energy expenditure and hypermetabolic state resulting from chronic hemolysis. This hypothesis is consistent with the correlation that observed between growth failure, anaemia and haemolysis markers (Alexandre-Heymann et al, 2019).In B-TM group, the IGFBP and IGF-1 were shown decrease levels compared to the control group, that was agreed with previous studies(De Sanctis et al, 2014;Riza1 et al, 2019; Al-Naama, Mea'adKadhum Hassan and Karim, 2020). GH is the most important factor controlling IGF-1 secretion and concentration.…”

“…A case control study that included (140) patients (50 patients with beta thalassemia major, 40 patients with beta thalassemia intermediate, and 50 patients with sickle cell anemia). The patients' ages were ranged from (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) years. All patients were diagnosed by specialist physicians and confirm by clinical examinations and laboratory investigations.…”

“…Repeated blood transfusions in thalassemia major patients may cause elevated levels of free iron in blood serum, which then converts hydrogen peroxide into hydroxide ion (OH -), leading to increased reactive oxygen species (ROS) and oxidative stress. Increased ROS decreases mRNA expression of IGF-1, leading to muscle atrophy, sarcomopenia, wasting, and myopathy(Riza1 et al, 2019). The area under the ROC curve for IGF-1 & IGFBP in B-TM was excellent for diagnostic accuracy, whereas sensitivity (100%) and specificity (100%) for both, these markers were highly acceptable for diagnostic test.In B-TIM, the IGFBP and IGF-1 were shown decrease level compared to the control group, this finding was agreed with previous studies(Dhouib et al, 2018;Yassin et al, 2019).…”

Factors Associated to Growth Disorder in Children with Thalassemia Major

“…It will affect the speed of bone growth on the bone growth plate so that the child's stature is short. 17,18,23 Hypogonadotropic-hypogonadism happens due to damage to the hypothalamus and anterior pituitary caused by hemosiderosis. The gonadotropins produced by the anterior pituitary are very sensitive to oxidative damage caused by iron overload.…”