The Quality of Life of Thalassemic Patients: The Role of Endocrine Defect Compensation

Abstract

Background: The improvement of beta thalassaemia treatments has led to an increase in life expectancy. This implies the emergence of new comorbidities. Amongst others, endocrine glands are extremely sensitive to iron overload. Objective: We aimed to understand the burden of the endocrine conditions on the patient’s quality of life (QOL). Results: Hypogonadism may present with lack or delay of pubertal development, sexual dysfunctions and impaired fertility, which impact QOL in both sexes. Early recognition and treatment, as well as choosing the most appropriate therapy, according to patient’s needs (fertility, pubertal development, psychological concerns, comorbidities) are advisable. Osteoporosis affects QOL irrespective of symptoms. Growth hormone deficiency may occur both in childhood and in adulthood, and it affects different aspects of QOL. In adults, it could be difficult to examine if the symptoms are due to GHD, and a trial of GH replacement could be useful to identify benefits and needs. Glucose metabolism impairment is common in thalassaemic patients and early recognition is mandatory because long-term complication can have a detrimental impact on QOL (as blindness or dialysis). Although the incidence of adrenal insufficiency seems to be rare in thalassaemic patients, when it occurs, it has a severe impact on QOL. Conclusion: Limited data is available on QOL in thalassaemic patients, and even less related to endocrinopathies. We can speculate that endocrinopathies have an impact on everyday life. More studies are needed to allow our patients to achieve not just a longer life but also a better quality of life.

Thalassemia‐related complications in pediatric, adolescent, and young adult patients with transfusion‐dependent thalassemia: A multicenter study in Thailand

“…Regarding previous study of disease-related complications in adolescent and adult Thai population with TDT and NTDT, [6][7][8] Thalassemia-related complications profoundly impact the medical and socioeconomic burden, including quality of life 30,31 for the patients with thalassemia, hence the importance of early clinical screening and management in particular complications of the respective age group should be emphasized. We found that the most common complications as infections were correlated with splenectomy and elevated pre-transfusion Hb.…”

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

“…TED massively impacts the medical and social burden, including the quality of life [ 45 ]. Specific therapy for BTH might improve endocrine involvement by correcting underling mechanisms such as IO; however, not all the studies agree on specific BTH treatment-ED association.…”

“…Since the patients with intermediate BTH have different clinical presentations, EDs vary, and a subgroup of subjects was similar to patients with major BTH with regards to the profile of EDs [ 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 ]. Overall, short stature affects both children and adults; GH/IG...…”