Iron-Storage Disorder Presenting as Chronic Diarrhea

Abstract

The involvement of the endocrine pancreas leading to bronze diabetes is well studied. However, little is known about the pathophysiology of iron dysregulation involving the exocrine pancreas. We present a unique association between the exocrine pancreas and iron dysregulation. A 45-year-old female presented with chronic diarrhea and low fecal elastase indicative of pancreatic exocrine dysfunction. MRI of the abdomen/pelvis showed iron deposition in the pancreas, suggesting an associated iron-storage disorder without features suggesting chronic pancreatitis. Association of an iron-storage disorder with pancreatic exocrine dysfunction has been reported only in one other case report. Pancreatic exocrine dysfunction can be directly associated with an iron-storage disorder that involves the pancreas. This should be included in the differential and diagnostic work-up of chronic diarrhea of unclear etiology. Based on the literature, we have highlighted the potential pathophysiology relevant to the case.

Keywords: chronic diarrhea; hemochromatosis; iron storage disorder; pancreatic exocrine insufficiency; pancreatic iron overload.

Figure 1. Comparison of Contrast-enhanced MRI-Axial HASTE section: Iron deposition depicted by dark black color in liver and pancreas - red arrows in image A vs. normal liver and pancreas 3 years ago depicted by grey color in liver and pancreas - blue arrows in image B.