scholarly journals Neonatal Hypopituitarism: Unusual Presentation

2017 ◽  
Vol 07 (01) ◽  
pp. e103-e105 ◽  
Author(s):  
Abdulsalam Abu-Libdeh ◽  
Bassam Abu-Libdeh ◽  
Ulla Abdulhag

Objective We report an infant with panhypopituitarism presenting with cholestatic jaundice, hypoglycemia, and high ferritin level. Methods We conducted clinical and laboratory investigations, including metabolic, infectious, and hormonal evaluation. Results Hormonal evaluation revealed panhypopituitarism (cortisol deficiency, growth hormone deficiency, and central hypothyroidism). Other causes of cholestasis were ruled out. Surprisingly, serum ferritin level was very high suggesting neonatal hemochromatosis, which was ruled out by the absence of hemosiderin deposition in buccal mucosal biopsy. Replacement therapy with glucocorticoids and L-thyroxin showed improvement of liver function tests, resolved cholestatic jaundice, and significantly decreased serum ferritin level. These findings support the assumption that thyroid hormone and cortisol affect the bile acid-independent bile flow. Conclusion This is the first description of an infant with congenital panhypopituitarism, presenting with cholestasis, hypoglycemia, and high serum ferritin level. Panhypopituitarism should be considered in any infant who presents with cholestasis, hypoglycemia, and other manifestations of pituitary malfunction. High serum ferritin level probably reflects acute phase reaction.

Author(s):  
Babaeva T.N. ◽  
Seregina O.B. ◽  
Pospelova T.I.

At present, the serum ferritin level is not included in the list of prognostic factors; however, it is known that its increased serum level in patients with malignant neoplasms relates with the tumor burden, the degree of disease activity and correlates with a worse prognosis in patients with hematologic malignancies.The normalization of serum ferritin level during remission period confirms the involving of hyperferritinemia in mechanisms of tumor progression and may testify for clinical importance of measurement of serum ferritin level in patients, including those with malignant lymphomas. Objective:The aim of this study was to assess of the prognostic significance of high ferritin levels at the onset of the disease in patients with malignant lymphomas. Materials and methods:98 patients with malignant lymphomaswere enrolled in this study, including 72 patients (73.5%) with non-Hodgkins lymphomas (NHL) and 26 patients (26.5%) with Hodgkin’s lymphoma (HL). The increased serum ferritin level (more than 350 ng/ml) was found in 53 (54.2%) patients with malignant lymphomas at the onset of disease and its average concentration was 587,62±131,6 ng/ml (8.3 times higher values of control group, p<0.001).Also the positive statistical correlationsbetween increased ferritin level and increased level of LDH (r=0.47, p<0.001, n=98) and C-reactive protein (r=0.41, p<0.001, n=98) as well as the presence of B-symptomswere found. The median OS was significantly shorter in the group of patients with increased ferritin level (more than 350 ng/ml) at the onset of disease in comparison with group of patients with normal ferritin level, where the median OS was not reach during the observation period. Patients with increased ferritin level before starting chemotherapy also showed worse results of overall survival and increased mortality risk (OR 8.122; 95% CI, 1.764-37.396;р<0.05) compare with a group of patients with ferritin level ˂350 hg/ml at the onset of disease. Conclusion:These results make it possible to include lymphomas’s patients with increased ferritin level at the onset of disease in the group with poor prognosis and lower OS, while the increased ferritin level in patients without previous blood transfusions should be considered as a significant prognostic factor.


2020 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
King Hans Kurnia ◽  
Elvioza Elvioza ◽  
Mohamad Sidik ◽  
Teny Tjitra Sari ◽  
Rita Sita Sitorus

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Ramadan A. Mahmoud ◽  
Ashraf Khodeary ◽  
Marwa S. Farhan

Abstract Background Beta thalassemia major (TM) is the most common inherited genetic disorder worldwide. Patients are at risk of iron overload, which leads to various forms of tissue damage, including endocrinopathies. The aim of this study was to evaluate the prevalence and risk factors of endocrine disorders in young patients with multi-transfused TM receiving iron chelation therapy. Methods The inclusion criteria included all known cases of TM according to hemoglobin electrophoresis data, aged 12 years or younger, during the study period. The patient’s age, gender, parent’s consanguinity, clinical examination, and types of iron chelating agents used were recorded. Serum ferritin level, complete blood count (CBC), blood glucose homeostasis, thyroid, and parathyroid functions were determined. Results One hundred twenty patients met the inclusion criteria; 70% of them had malnutrition. The presence of endocrine disorders was observed in 28/120 (23.33%) patients. The most common endocrine disorders were thyroid disorders, either subclinical or clinical hypothyroidism in 11/120 (9.17%) patients, followed by abnormalities in glucose homeostasis 9/120 (7.5%). The prevalence of impaired glucose tolerance, impaired fasting glucose, and diabetes mellitus in the present study was 5 (4.17%), 4 (3.33%), and 0 (00%), respectively, while the least frequent endocrine disorder seen in our patients was hypoparathyroidism in 8/120 (6.66%). We noted that high serum ferritin levels and poor patient compliance to therapy were significantly associated with increased endocrine disorders (OR 0.98, 95% CI 0.96–0.99, P = 0.003 and OR 0.38, 95% CI 0.16:0.93, P = 0.03, respectively). Combined chelating iron agents significantly decreased the prevalence of endocrine disorders when compared with monotherapy (OR 0.40, 95% CI 0.16:0.97, P = 0.04). Conclusion Endocrine disorders could occur in TM patients early before or equal to 12 years of life in about one-fourth of the patients. A high serum ferritin level and poor patient compliance to therapy were significantly associated with increased endocrine disorders. Combined iron-chelating agents were associated with a decreased prevalence of endocrine disorders when compared with monotherapy.


2016 ◽  
Vol 100 (12) ◽  
pp. 1703-1707 ◽  
Author(s):  
Hyo Jung Gye ◽  
Joon Mo Kim ◽  
Chungkwon Yoo ◽  
Seong Hee Shim ◽  
Yu Sam Won ◽  
...  

2013 ◽  
Vol 3 (1) ◽  
pp. S7
Author(s):  
Rakhi Maiwall ◽  
A. Rastogi ◽  
A.K. Chaudhary ◽  
Jaswinder Singh Maras ◽  
Chitranshu Vasisht ◽  
...  

Author(s):  
Abhijit Das ◽  
Shreyasi Karmakar ◽  
Sabyasachi Bid ◽  
Sudip Kumar Saha

Introduction: Gestational Diabetes Mellitus (GDM) has a negative impact on maternal and perinatal outcome and several long-term complications. The evidence from different experimental studies have shown that high serum ferritin concentration can lead to pancreatic β-cell dysfunction and impaired glucose metabolism leading to GDM. Aim: To determine the association of increased serum ferritin level in first trimester and GDM in course of pregnancy. Materials and Methods: A prospective observational study was conducted in 204 women in Institute of Post Graduate Medical Education and Research and SSKM Hospital, West Bengal, India, during the period from January 2015 to December 2015. The blood samples were collected and screened for GDM by Oral Glucose Tolerance Test (OGTT) at the beginning of the study and then assayed for serum ferritin level who were screened negative. The women were divided into four groups by quartiles of serum ferritin levels (Q1 to Q4). Then they were followed-up with OGTT at 24-28 weeks and again at 32-34 weeks. Statistical analysis was done by using paired t-test, Chi-square test and Fisher’s- exact test. Results: The participants had an average serum ferritin concentration of 77.44 ng/mL. GDM prevalence within each serum ferritin quartile was 7.84%, 11.76%, 19.61% and 23.53% respectively (p-value=0.016). The odds ratio for GDM in the ferritin Q2-Q4 was 1.57 (CI=0.41-5.92), 2.87 (CI=0.84-9.83) and 3.62 (CI=1.08-12.11) compared with Q1, respectively. In addition, primigravida and women with high Haemoglobin (Hb) level (>13 gm%) have an increased risk of developing GDM. Conclusion: Elevated serum ferritin level is associated with increased incidence of GDM irrespective of other risk factors. Iron supplementation should therefore be individualised based on serum ferritin in early pregnancy to minimise the risk of GDM.


2017 ◽  
Vol 9 (1) ◽  
pp. 2017037 ◽  
Author(s):  
Vincenzo De Sanctis

Abstract. Introduction: Sickle cell disease (SCD) is an important cause of morbidity and mortality worldwide, causing damage and dysfunction in multiple organs. The complications of this disease are numerous, affect every organ and/or tissue in the body and vary considerably among patients over the time which challenge its management. Aim of our study: To determine the iron status of 17 patients with NT-SCD patients and 6 patients with TD- SCD using both serum ferritin level (SF ) and Ferriscan® evaluation of liver iron content (LIC) and correlate values of LIC on the one hand with SF levels and some hepatic functions (ALT, AST, ALP and albumin).  Results: 17 adults with NT-SCD (n = 17, age: 32±15 years) were studied.  Seven of NT-SCD had serum ferritin > 500 μg/L, 4 out of the seven had high liver iron measured by FerriScan®  (> 30 mg/kg/ tissue dry weight - DW).  Two patients had high liver iron content despite a concomitant serum ferritin concentration < 500 μg/L.  Two patients had high serum ferritin (1.117 μg/L and 675 μg/L) while their LIC was normal (< 30 mg/kg/DW).  5 patients had elevated ALT and/or AST concentrations. In TD-SCD (n = 6, age = 25 ±11 years), 2 patients had serum ferritin <500 μg/L, one of them had high LIC (127 mg/kg/DW). Liver enzymes were high in two patients.  Serum ferritin concentration was correlated significantly with LIC  (r = 0.85, p < 0.001). Neither serum ferritin level, nor LIC was correlated significantly with hepatic enzyme levels. Conclusions:  A significant number of our patients with ND-SCD had high LIC , high serum ferritin and elevated hepatic enzymes (ALT and AST). Despite some  limitations of our study (small NT-SCD cohort),  these findings have important clinical implications. We recommend  to measure serum ferritin and LIC in NT-SCD patients to apply therapeutic preventive measures with iron chelation therapy in patients with high LIC.  


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