Pancreatic iron stores assessed by magnetic resonance imaging (MRI) in beta thalassemic patients

Assis, Reijane Alves de; Ribeiro, Andreza Alice Feitosa; Kay, Fernando Uliana; Rosemberg, Laércio Alberto; Nomura, César Higa; Loggetto, Sandra Regina; Araújo, Aderson da Silva; Fabron, Antonio; Veríssimo, Mônica Pinheiro de Almeida; Baldanzi, Giorgio Roberto; Espósito, Breno Pannia; Baroni, Ronaldo Hueb; Wood, John C.; Hamerschlak, Nelson

doi:10.1016/j.ejrad.2011.03.077

Cited by 52 publications

(63 citation statements)

References 13 publications

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“…Hepatic (R2 and T2*) and cardiac (T2*) MRI relaxation time techniques have been calibrated against biopsy specimens, and results achieved international reproducibility [29][30][31][32][33]. MRI evaluation of iron content for some endocrine glands, mainly the pancreas and pituitary, also appears to be feasible [34][35][36][37][38]. However, MRI techniques are not always available, especially in developing countries with limited health care resources, where serum ferritin measurement is the only available option.…”

Section: Discussionmentioning

confidence: 97%

Serum ferritin levels and endocrinopathy in medically treated patients with β thalassemia major

et al. 2012

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The association between iron overload indices and pathology of the heart and liver in transfusion-dependent patients with β thalassemia major (TM) has been extensively studied. Nonetheless, data on endocrine disease remains limited. This was a cross-sectional study of 382 TM patients treated with regular transfusions and desferrioxamine at the Thalassemia Center in Dubai, UAE. Retrieved data included demographics, splenectomy status, steady-state serum ferritin levels, and the presence of endocrinopathies (diabetes mellitus, hypothyroidism, hypoparathyroidism, and hypogonadism). Multivariate logistic regression analyses were used to determine which variables were independently associated with the occurrence of each endocrinopathy. The mean age of patients was 15.4 ± 7.6 years, with an equal sex distribution. The mean serum ferritin level was 2597.2 ± 1976.8 μg/l. The frequencies of specific endocrinopathies were diabetes mellitus (10.5%), hypothyroidism (6.3%), hypoparathyroidism (10.5%), and hypogonadism (25.9%). On multivariate logistic regression analysis, patients with a serum ferritin level >2,500 μg/l, but not >1,000-2,500 μg/l, were 3.53 times (95% CI 1.09-11.40) more likely to have diabetes mellitus, 3.25 times (95% CI 1.07-10.90) more likely to have hypothyroidism, 3.27 times (95% CI 1.27-8.39) more likely to have hypoparathyroidism, and 2.75 times (95% CI 1.38-5.49) more likely to have hypogonadism compared to patients with a serum ferritin level ≤1,000 μg/l. However, splenectomized patients with serum ferritin levels ≤2,500 μg/l had comparably high rates of all endocrinopathies as patients with serum ferritin levels >2,500 μg/l. Endocrinopathy is common in TM patients treated with desferrioxamine therapy, especially in patients with serum ferritin levels >2,500 μg/l or those splenectomized.

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Section: Discussionmentioning

confidence: 97%

Serum ferritin levels and endocrinopathy in medically treated patients with β thalassemia major

et al. 2012

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“…However OGTT compliance is often poor. Pancreatic iron overload can be assessed my MRI [52] but doesn't seem to correlate with siderosis in other organs.…”

Section: Glucose Intolerance and Diabetes Mellitusmentioning

confidence: 99%

A Review of Endocrine Disorders in Thalassaemia

De¹,

Mistry²,

Wright³

et al. 2014

OJEMD

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Endocrine dysfunction in thalassaemia is amongst the most common complication and is principally attributed to excessive iron overload and suboptimal chelation. The prevalence is quite high particularly in multiethnic populations but determining the prevalence is often difficult due to the widespread heterogeneity of the population and timing of exposure to chelation therapy. Disturbances in growth, pubertal development, abnormal gonadal functions, impaired thyroid, parathyroid and adrenal functions, diabetes and disorderly bone growth are commonly encountered. Early detection and institution of appropriate transfusion regimen and chelation therapy and treatment of complications are the keys to managing this population including regular follow. In this article, we review the literature in relation to the various endocrine complications encountered in thalassaemia.

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“…28 Both pancreas and cardiac R2* are correlated with glucose intolerance and diabetes. 27,41,42 The presence of detectable cardiac iron is a relatively good predictor of overt diabetes, but lacks sensitivity for milder glucose dysregulation. 42 Pancreas R2* Ͼ 100 Hz is sensitive for all forms of glucose dysregulation (impaired fasting glucose, impaired glucose tolerance, and diabetes), but half of these patients will have normal glucose handling (Noetzli LJ, Mittelman SD, Watanabe RM, Coates TD, and Wood JC, unpublished data).…”

Section: Mri Assessment Of Pancreas R2*mentioning

confidence: 99%

“…For inaccessible organs such as the pituitary and pancreas glands, absolute iron concentrations may never be derived; however, the R2 and R2* values associated with glandular dysfunction and destruction are under investigation. [25][26][27][28] Although most 1.5 Tesla magnets are intrinsically able to perform iron estimation measurements, specialized software and local expertise/training are required for accurate assessment. As a result, some centers have chosen to purchase commercial software or outsource their image analysis to fee-for-service vendors rather than commit the resources to obtain the measurements themselves.…”

Section: Experimental Calibration Versus Validationmentioning

confidence: 99%

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Impact of Iron Assessment by MRI

Wood

2011

Hematology

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119

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The use of magnetic resonance imaging (MRI) to estimate tissue iron was conceived in the 1980s, but has only become a practical reality in the last decade. The technique is most often used to estimate hepatic and cardiac iron in patients with transfusional siderosis and has largely replaced liver biopsy for liver iron quantification. However, the ability of MRI to quantify extrahepatic iron has had a greater impact on patient care and on our understanding of iron overload pathophysiology. Iron cardiomyopathy used to be the leading cause of death in thalassemia major, but is now relatively rare in centers with regular MRI screening of cardiac iron, through earlier recognition of cardiac iron loading. Longitudinal MRI studies have demonstrated differential kinetics of uptake and clearance among the difference organs of the body. Although elevated serum ferritin and liver iron concentration (LIC) increase the risk of cardiac and endocrine toxicities, some patients unequivocally develop extrahepatic iron deposition and toxicity despite having low total body iron stores. These observations, coupled with the advent of increasing options for iron chelation therapy, are allowing clinicians to more appropriately tailor chelation therapy to individual patient needs, producing greater efficacy with fewer toxicities. Future frontiers in MRI monitoring include improved prevention of endocrine toxicities, particularly hypogonadotropic hypogonadism and diabetes.

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Pancreatic iron stores assessed by magnetic resonance imaging (MRI) in beta thalassemic patients

Cited by 52 publications

References 13 publications

Serum ferritin levels and endocrinopathy in medically treated patients with β thalassemia major

Serum ferritin levels and endocrinopathy in medically treated patients with β thalassemia major

A Review of Endocrine Disorders in Thalassaemia

Impact of Iron Assessment by MRI

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