The Correlation between Pituitary Gonadotrophins, Gonadal Sex Steroid Hormone with Ferritin Level in Pubertal Females with Thalassemia Major at Wassit Province - Iraq 2020

Abstract

Thalassemia Major still a growing disease in Iraq with no clear plan for prevention.
 Failure to get a secondary sexual character, amenorrhea, and then the inability to get pregnant is one the increasingly common problems in female patients with huge burden effects. Despite recent advances in iron chelation therapy, still, excess iron deposition in pituitary gonadotropic and gonadal cells remains one of the major causes for gonadal failure.
 Objectives: To evaluate the effect of iron overloads measured by serum ferritin on pituitary gonadotrophins measured by FSH, LH, and the gonadal sex steroid measured by estrogen in pubertal females with thalassemia Major.
 Methods: 41 female patients randomly selected in a cross-sectional study with diagnosed Thalassemia Major registered in Al-Kut Hereditary Blood Disease Center in the south of Iraq.
 Demographic data were evaluated including (age, type of chelation therapy, compliance for treatment and mean hemoglobin levels, and presence of amenorrhea). Serum ferritin, hemoglobin, FSH, LH, Estrogen levels were collected from patient's files. 
 Results: the age of the studied sample were range from 14-43 years. The majority of the studied patients 33(80.5%) were suffering from primary amenorrhea and only six had a normal menstrual cycle. Twenty-six (63.4%) patients had serum ferritin levels of more than 3000 ng/dl.
 A low average serum FSH, LH, and Estrogen concentration were observed in the group with serum ferritin levels more than 3000ng/dl in a statistically significant p-value, 0.001, 0.002, and 0.003 respectively with inverse Pearson's correlation (-0.4 and p-value 0.0009 for FSH), (- 0.2 with no significant p-value 0.12, for LH) and (-0.3 with significant p. value 0.02 for estrogen level). 
 Conclusions:
 In this study majority of females with thalassemia, Major suffer from disruption of pituitary gonadotropins and possible gonadal sex steroid. High ferritin still is a statistically significant risk factor for gonadal failure.
 The needs for more strict iron control, early screening, and proper treatment of gonadotropin and gonadal sex steroid deficiency around the age of 13 years are essential to be offered. More studies and a larger sample are needed to confirm and/or add other risk factors in pubertal thalassemic females.