Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Jan;18(1):32-8.
doi: 10.4103/2230-8210.126525.

Growth hormone - insulin-like growth factor-I axis and bone mineral density in adults with thalassemia major

Ashraf Soliman  1 , Vincenzo De Sanctis  2 , Mohamed Yassin  3 , Mohamed O Abdelrahman  4
Affiliations

Growth hormone - insulin-like growth factor-I axis and bone mineral density in adults with thalassemia major

Ashraf Soliman et al. Indian J Endocrinol Metab. 2014 Jan.

Abstract

Introduction: Bone disease and short stature are frequent clinical features of patients with beta-thalassaemia major. Dysfunction of the GH-IGF-1 axis has been described in many thalassemics children and adolescents with short stature and reduced growth velocity. Assessment of the GH-IGF-1 axis in short adults with TM after attainment of final height may be required to select those who are candidates for replacement therapy and to prevent the development of bone disease. The aim of our study was to investigate GH secretion in adult thalassemic patients in relation to their bone mineral density (BMD) and serum ferritin concentrations.

Materials and methods: We performed clonidine stimulation test in 30 thalassemic patients (18 males, 12 females) with a mean age of 31.5± 7.2 years. The cut-off level for GH response was set at 7ug/l, according to the literature. Serum ferritin, IGF-I, liver enzymes, alkaline phosphatase (ALP) and type 1 Collagen Carboxy Telopeptide (CCT1) were also determined.

Results: We diagnosed GH deficiency (GHD) in 12 patients (40%) and IGF-I deficiency (IGF-I SDS <-2) was diagnosed in 20 patients (67%). Adult patients with TM had significantly decreased IGF-I concentrations and bone mineral density (BMD) at the femur neck and lumbar spine compared to normal controls. Thalassemic patients with GHD and IGF-I deficiency had significantly lower BMD T score at the lumbar spine compared to patients with normal GH and IGF-I levels. Thalassemic patients had higher serum CCT1 concentrations compared to normal controls. Peak GH levels were correlated significantly with IGF- I concentrations and IGF-I levels were correlated significantly with the height SDS (HtSDS) of thalassemic patients. Neither GH peak nor IGF-I concentrations were correlated to serum ferritin concentrations.

Conclusions: We conclude that GH status should be tested in adult thalassemic patients especially those with short stature and/or decreased BMD. Clonidine test appears to be effective and safe in adults with TM. If the diagnosis of adult GHD is established, GH treatment may be considered for possible improvement of bone mineral density and heart function in patients with TM.

Keywords: Bone mineral density; GH deficiency GHD; ferritin; growth; growth hormone; insulin like growth factor –I; prevalence; thalassemia.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: None declared.

Figures

Figure 1
Figure 1
Regression of HtSDS on IGF-I Concentrations in adults with thalassemia
Figure 2
Figure 2
Regression of peak growth hormone on bone mineral density T score of Lumbar vertebrae
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Toumba M, Sergis A, Kanaris C, Skordis N. Endocrine complications in patients with Thalassaemia Major. Pediatr Endocrinol Rev. 2007;5:642–8. - PubMed
    1. Delvecchio M, Cavallo L. Growth and endocrine function in thalassemia major in childhood and adolescence. J Endocrinol Invest. 2010;33:61–8. - PubMed
    1. Vidergor G, Goldfarb AW, Glaser B, Dresner-Pollak R. Growth hormone reserve in adult beta thalassemia patients. Endocrine. 2007;31:33–7. - PubMed
    1. Scacchi M, Danesi L, Cattaneo A, Valassi E, Pecori Giraldi F, Argento C, et al. Growth hormone deficiency in adult thalassaemic patients. Clin Endocrinol (Oxf) 2007;67:790–5. - PubMed
    1. La Rosa C, De Sanctis V, Mangiagli A, Mancuso M, Guardabasso V, Galati MC, et al. Growth hormone secretion in adult patients with thalassaemia. Clin Endocrinol (Oxf) 2005;62:667–71. - PubMed