ENDOCRINE SYSTEM

THYROID, PARATHYROID DYSFUNCTION, PITUITARY

Excess iron affects the ENDOCRINE system in many ways.  All HH patients should have a complete endocrine evaluation at diagnosis. 

Hypothyroidism, always feeling cold, hair loss or early graying, fatigue, psychological disorders, depression, confusion, memory loss are some of the symptoms which may be associated with iron overload in these glands. 

In the first section are links to thyroid/parathyroid dsyfunction & HH.  In the second half are links which are specific to pituitary dysfunction & HH.

THYROID, PARATHYROID DYSFUNCTION
Some studies indicate that an HH patient has an 80x greater risk of developing thryoid problems

• Amyloid goiter in a case of systemic amyloidosis secondary to ankylosing spondylitis.  
  J Endocrinol Invest. 2000 Dec Infiltrative diseases of the thyroid include systemic sclerosis, hemochromatosis, sarcoidosis, chondrocalcinosis and amyloidosis.

• Change in the thyroid function by use of deferoxamine in a patient with hemochromatosis complicated by hyperthyroidism. J Med. 1992 We report on a 74-year-old female patient with primary hemochromatosis complicated by hyperthyroidism. The serum ferritin level was reduced throughout a 217 day administration of deferoxamine (1 g/day). At the same time, the thyroid gland was changed from hyper- to hypo- functional proportionally.

• Clinico-morphologic characteristics of primary hemochromatosis
   Arkh Patol. 1995 Nov-Dec 12 autopsy cases of primary hemochromatosis were studied

• Correlation between the depth of inverted T waves and the serum level of ferritin in a deferoxamine-treated patient with primary hemochromatosis and hyperthyroidism.   Jpn J Med. 1989 Mar-Apr There seemed to be a correlation between the depth of inverted T waves and the serum level of ferritin.

• Dr. Rose's Peripheral Brain--HEMOCHROMATOSIS

• Elevated parathyroid hormone 44-68 and osteoarticular changes in patients with genetic hemochromatosis Arthritis Rheum 1999 Apr  Liver iron overload syndromes, especially genetic hemochromatosis, are associated with elevated circulating levels of PTH fragments containing the 44-68 region, which appears to play a role in osteoarticular changes. This increase seems to be a consequence of iron overload.

• Hemochromatosis: genetics helps to define a multifactorial disease 
  Clin Genet, 54(1):1-9 1998 Jul University of Washington, Seattle 98105 wburke@u.washington.edu  Early detection is desirable, because periodic phlebotomy provides effective treatment for iron overload and may prevent complications of the disorder.

• Hemochromatosis:  Life Extension Foundation website.  Disease, Prevention & Treatment 3rd editon.  Dietary & Vitamin recommendations listed here including calcium for blocking of iron absorption.

• Hereditary Hemochromatosis FamilyPractice.com  Robert B. Hash, MD, Department of Family Medicine, Mercer University School of Medicine, Macon, Ga. [J Am Board Fam Pract Dec. 2000] Considering the prevalence of the disease, it is important for physicians to consider it in the differential diagnosis when patients complain of the common signs and symptoms. For most patients hereditary hemochromatosis can be successfully treated in the physician's office. Early diagnosis and treatment, before signs of iron toxicity, if possible, can result in improved quality and quantity of life for many patients.

• Hypothyroidism and hypoparathyroidism in an 11 year old boy with hemochromatosis secondary to aplastic anemia.  Acta Paediatr Jpn. 1995 Aug  This is the first reported case, to our knowledge, of hypoparathyroidism and hypothyroidism due to secondary hemochromatosis with onset during childhood. The patient was a boy with refractory aplastic anemia in whom primary hypothyroidism and hypoparathyroidism became apparent at the age of 10 and 11 years old, respectively.

• Hypothyroidism and Iron Levels: Anemia and Hemachromatosis
  by Mary Shomon  Conditions related to iron levels in the blood are more common with hypothyroidism than in the average population, according to researchers. 

• MR imaging of the thyroid and parathyroid glands. 
  Magn Reson Imaging Clin N Am. 2000 Feb MR imaging also has been used for the investigation of congenital disorders of the thyroid gland and the evaluation of diffuse thyroid disease, such as Grave's disease, Hashimoto's and Riedel thyroiditis, and hemochromatosis

• MR imaging of thyroid hemochromatosis.
  J Comput Assist Tomogr. 1988 Jul-Aug  We present the magnetic resonance (MR) images of exogenous hemochromatosis in the thyroid gland. On both T1-weighted images and T2-weighted images the thyroid showed low intensity similar to that of the background. Magnetic resonance is of value in imaging the tissue deposition of iron. In assessing thyroid iron accumulation, MR is superior to CT because CT can not differentiate iron deposition from normal iodine concentration.

• Overview of Thyroid Disorders New York Thyroid Center Home

• Thyroid disease in hemochromatosis. Increased incidence in homozygous men.
  Arch Intern Med. 1983 Oct  Iron may have caused injury to the thyroid, followed by the development of antithyroid antibodies and hypothyroidism. The frequency of thyroid disorders in men with hemochromatosis is about 80 times that of men in the general population.

• Too much iron can hurt joints, body organs
  The Albuquerque Tribune. By John Crowe The Associated Press 1/11/00

• YOUR THYROID from EndocrineWeb.com including:
  Common Tests to Examine Thyroid Gland Function
  How Your Thyroid Works  "A delicate Feedback Mechanism"

PITUITARY DYSFUNCTION

• Clinico-morphologic characteristics of primary hemochromatosis
   Arkh Patol. 1995 Nov-Dec 12 autopsy cases of primary hemochromatosis were studied

• Current concepts in rational therapy for haemochromatosis.
  Drugs. 1991 Jun . Venesection should be continued until all excess iron stores are removed as judged by failure of a rise in haemoglobin concentration on cessation of phlebotomy. Screening of first degree relatives should commence from a young age (e.g. 10 years).

• Diagnosis and management of hemochromatosis
  by Dr. Anthony Tavill, Director of the Maurice and Sadie Friedman Center For Digestive Diseases and Liver Disorders, Mathile and Morton J. Stone Professor of Digestive Diseases and Liver Disorders at the Mt. Sinai Medical Center, Professor of Medicine and Nutrition at Case Wetern Reserve University. [Excellent & thorough article of diagnosis & treatment.  This is a pdf file] 

• Endocrine abnormalities in idiopathic haemochromatosis.  Q J Med. 1983 Winter  Impairment of anterior pituitary function occurs in idiopathic haemochromatosis but is selective; gonadotrophin and prolactin deficiencies are common. Clinical hypogonadism is usually hypogonadotrophic in origin.

• Endocrine complications of genetic hemochromatosis
  Acta Clin Belg   1999 Dec  Impairment of anterior pituitary function occurs in idiopathic haemochromatosis but is selective; gonadotrophin and prolactin deficiencies are common.

• Haemochromatosis as an endocrine cause of subfertility. 
  BMJ 1998;316:915-916 ( 21 March ) Clinical review.  Lesson of the week.   Haemochromatosis is well established as a cause of infertility in both men and women, usually because iron deposition in the pituitary or the gonads leads to hypogonadism.  As haemochromatosis is a fairly common disorder it should be considered when subfertility from an endocrine disorder is being investigated.

• Hemochromatosis: A Common, Rarely Diagnosed Disease
  By Vincent J. Felitti, MD, FACP  Commentary by David Baer, MD, FACP.  Hemochromatosis is the most common, life-threatening genetic disorder in North America, yet most physicians have never personally diagnosed a case: all see an unrecognized case in their offices every two weeks.

• Hemochromatosis, Cooley Dickinson Hospital  Editor: George R Bowers MD CDH Oncology  January 2000 Volume 4: No. 1.   Hemochromatosis is a common, genetically transmitted disease. The diagnosis of hemochromatosis is sometimes difficult and frequently missed. This issue will review the pathogenesis, diagnosis and treatment of this fascinating disease. Ms. Kathy Fleming will review the management of a most troubling complication of therapy---lymphedema. 

• Hemochromatosis: Gastrointestinal Health Hemochromatosis, the most common genetic disease in the United States, results in iron overload and, if left untreated, severe organ damage.  This is the website of the Jewish Hospital in Louisville, Ky. 2/2000 [you must sign into their site & use their search engine to find this section on hemochromatosis.]

• Hemochromatosis: genetics helps to define a multifactorial disease 
  Clin Genet, 54(1):1-9 1998 Jul University of Washington, Seattle 98105 wburke@u.washington.edu  Early detection is desirable, because periodic phlebotomy provides effective treatment for iron overload and may prevent complications of the disorder.

• Hemochromatosis of the pituitary gland: MR imaging 
  Radiology, Vol 168, 213-214 1988 Magnetic resonance imaging of the pituitary gland in a patient with secondary hemochromatosis is described. On T1-weighted images, the anterior lobe had almost no signal intensity, and only the high-signal posterior lobe was seen. These findings are compatible with the distribution of iron deposition and clinical symptoms in hemochromatosis.

• Hereditary haemochromatosis: never seen a case?
  Editorial.  The British Journal of General Practice, Royal College of General Practitioners.  Early symptoms of HHC are frequently non-specific, such as fatigue, arthralgia, and abdominal pain and only later do features such as diabetes, impotence, cardiac failure, arrhythmias, amennorhoea, and skin pigmentation develop. Consequently diagnosis is often delayed

• Hereditary Hemochromatosis and Cancer risk:  More fuel to the fire?  Gastroenterology Vol. 121, No. 5, November 2001  Pg. 1253 [a pdf file]  These data suggest an involvement of iron in carcinogenesis even in heterozygotes for HFE mutations. 

• Hereditary hemochromatosis.  Ann Clin Lab Sci. 1998 Sep-Oct   Patients at risk for genetic hemochromatosis should be screened, identified, and treated as early as age 20 to prevent or minimize the deadly complications of hemochromatosis. Population screening should include measurements of serum iron concentration, total iron binding capacity (TIBC), percent saturation of transferrin, and serum ferritin concentrations.  Early diagnosis and treatment will reduce the population of aging individuals with severe, complicated hemochromatosis and dramatically reduce medical costs (billions of U.S. dollars per annum) associated with the management of this disease.

• Hypogonadotropic hypogonadism in idiopathic hemochromatosis: evidence for combined hypothalamic and pituitary involvement 
  J Endocrinol Invest 1990 Nov   Hypogonadism is a common finding in idiopathic hemochromatosis. Most studies have localized the defect to either the pituitary gland or the testes.

• Hypopituitarism in primary haemochromatosis; recovery after iron depletion  Postgraduate Medical Journal, 1995, Vol 71, 297-298  We report a case of primary haemochromatosis complicated by anterior hypopituitarism which recovered after aggressive venesection therapy. Reversal of anterior hypopituitarism in haemochromatosis following iron depletion has not been previously described.

• Idiopathic hemochromatosis in a 45-year-old infertile man.
  Andrologia. 1987 Sep-Oct The clinical manifestations of primary or idiopathic hemochromatosis include mainly hepatomegaly, diabetes mellitus, and hypogonadism.

• Iron Loading and Disease Surveillance
  Eugene D. Weinberg   Indiana University, Bloomington, Indiana   Emerging Infectious Diseases Journal, National Center for Infectious Diseases, Centers for Disease Control and Prevention. Excessive iron in specific tissues and cells (iron loading) promotes development of infection, neoplasia, cardiomyopathy, arthropathy, and various endocrine and possibly neurodegenerative disorders.

• Iron Overload Disease due to Hereditary Hemochromatosis  CDC website, National Center for Chronic Disease Prevention and Health Promotion.  Early detection and treatment for this genetic condition can lessen morbidity and mortality, and in some cases prevent the onset of disease. Therefore, early detection of hemochromatosis represents a major chronic disease prevention opportunity.

• Iron Overload (Hemosiderosis; Hemochromatosis) The Merck Manual of Diagnosis and Therapy Section 11. Hematology And Oncology Chapter 128. Hemochromatosis is often diagnosed late in the course of disease after significant tissue injury is present because the clinical symptoms are insidious and the extent of organ involvement varies; thus, the full clinical picture evolves slowly.

• Magnetic resonance imaging of the pituitary gland in patients with secondary hypogonadism due to transfusional hemochromatosis. 
  MAGMA. 1999 May  The lower the signal intensity of the pituitary gland, the greater the serum ferritin level.  The detection of pituitary iron overload on GRE T2*-weighted images is consistent with the hypothesis of hypogonadotrophic pituitary insufficiency due to iron-induced cellular damage.

• Overview on Iron Overload and Hemochromatosis CDC website, National Center for Chronic Disease Prevention and Health Promotion.  Early detection of hemochromatosis is essential because the disease’s potentially serious complications can be prevented by early therapy.

• Pathology Cases for Diagnosis: A 37 year old male is referred to the liver clinic for evaluation of abnormal liver related enzymes.  Includes pictures of biopsy slides. Case 96-19: Liver II Contributed by D. Robert Dufour, M.D., CAPT, MC, USNR-R Date Available: July 22, 1996 - December 31, 1996

• Pituitary function in hemochromatosis
  Ugeskr Laeger. 1996 Mar 25 [Article in Danish] Investigation of pituitary function (in first line the gonadotropic and the somatotropic function) in patients with primary or secondary haemochromatosis is recommended on wide indications, in order to initiate relevant substitution therapy.

• Pituitary gland. Variable signal intensities on MRI. A pictorial essay.
  Clin Imaging. 1998 Sep-Oct Low T2w signal may be seen in hemorrhage, calcification, cystic lesion, hemochromatosis, melanoma, and vascular lesions. These are described and illustrated.

• Screening for Iron Overload due to Hereditary Hemochromatosis 
  CDC website, Reyes, Michele, PhD and Muin J. Khoury, MD, PhD,  National Center for Chronic Disease Prevention and Health Promotion  Identifying people early with evidence of iron overload represents a major chronic disease prevention opportunity.

• The articular damage of hemochromatosis. A little known aspect Recenti Prog Med 1999 Apr The aim of this report is to underline that the patients with premature osteoarthritis or unexplained chondrocalcinosis must be screened for genetic haemochromatosis in order to formulate the correct diagnosis before the development of severe internal organ involvement

Click on this link to read about HH. Discussion of a liver biopsy is also here:

Back to the "Munnsters" main Hemochromatosis page