Endocrine Abstracts

JOINT952

Background: Thalassemia major, a transfusion-dependent disorder, is commonly associated with chronic iron overload, resulting in significant endocrine dysfunctions such as impaired growth and delayed puberty. While serum ferritin is widely used as a marker of iron burden, it lacks specificity in predicting organ-specific damage. Magnetic resonance imaging (MRI) provides a more detailed evaluation of iron deposition, particularly in the pituitary gland, liver, pancreas, and heart. Understanding these correlations is critical for early diagnosis and effective management.

Objective: To assess the relationship between ferritin levels, MRI findings, and endocrine dysfunction, with a specific focus on pituitary MRI changes in thalassemia major.

Methods: A systematic review of 20 studies published from 2000 to 2025 was conducted, encompassing over 2,000 patients. The analysis included data on MRI-detected iron overload in the pituitary, pancreas, liver, and heart and their correlations with endocrine dysfunction. Relative impacts of iron burden were calculated based on MRI findings and ferritin correlations.

Results: • Pituitary Findings: MRI revealed reduced pituitary volume, hypointense T2* signals (<20 ms), and structural abnormalities. These findings were associated with hypogonadotropic hypogonadism and growth hormone deficiency, contributing to delayed puberty and stunted growth. The relative impact of pituitary iron overload was 80%, with a moderate ferritin correlation (0.8).

• Pancreatic Findings: Low T2* values (<20 ms) correlated with diabetes mellitus and glucose intolerance. The relative impact was 50%, and ferritin showed a weak correlation (0.5), highlighting the superior predictive value of MRI for pancreatic iron.

• Liver Findings: Liver iron concentration (LIC >7 mg/g dry weight) moderately correlated with ferritin (0.7) and was linked to thyroid and adrenal dysfunction, with a relative impact of 70%.

• Cardiac Findings: Low T2* values (<20 ms) reflected iron overload associated with cardiomyopathy risk. Ferritin showed a weak correlation (0.4), with a relative impact of 40%.

Conclusion: MRI is crucial in detecting organ-specific iron overload and its association with endocrine dysfunctions. Pituitary MRI findings strongly correlate with hormonal abnormalities and growth retardation, emphasizing its diagnostic and prognostic value. Ferritin, while accessible, often underestimates localized iron burden. Combining MRI with ferritin measurements improves diagnostic accuracy and facilitates early, targeted interventions to manage endocrine complications effectively.

Keywords: Thalassemia major, MRI, iron overload, ferritin, endocrine dysfunction, growth retardation, pituitary abnormalities.