Evaluation of Adrenal Insufficiency in Thalassemia Patients – 50 Cases in BSMMU, Dhaka, Bangladesh

Abstract

Background: Thalassemia is a hereditary hemoglobinopathy characterized by chronic hemolytic anemia requiring regular blood transfusions. Repeated transfusions and iron overload may affect endocrine organs, including the adrenal glands, leading to adrenal insufficiency (AI). Limited data exist regarding AI prevalence among thalassemia patients in Bangladesh. This study aimed to evaluate adrenal function in thalassemia patients attending Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. Methods: This prospective cross-sectional study included 50 patients with transfusion-dependent thalassemia (TDT) aged 5–30 years, attending the Biochemistry and Molecular Biology Department of BSMMU from January 2022 to December 2022. Baseline demographics, clinical history, and transfusion details were collected. Serum cortisol levels were measured at 8:00 AM, and low-dose ACTH stimulation tests (1 μg ACTH) were performed to assess adrenal reserve. Serum ferritin was measured as a marker of iron overload. AI was defined as peak serum cortisol <18 μg/dL after ACTH stimulation. Data were analyzed using SPSS version 26. Continuous variables were expressed as mean ± SD, and categorical variables as percentages. Associations between AI and clinical/biochemical parameters were analyzed using chi-square and t-tests. Results: Among 50 thalassemia patients, 28 (56%) were male and 22 (44%) females, with a mean age of 16.8 ± 6.2 years. The mean serum ferritin was 2870 ± 1025 ng/mL. Adrenal insufficiency was detected in 12 patients (24%). AI prevalence was higher among patients with serum ferritin >3000 ng/mL (P=0.03) and those with disease duration >15 years (P=0.01). There was no significant association with sex or age. Common clinical features of AI included fatigue (80%), hypotension (50%), and poor growth (30%). Conclusion: Adrenal insufficiency is a relatively common endocrine complication among transfusion-dependent thalassemia patients in Bangladesh, particularly in those with severe iron overload and longer disease duration. Routine adrenal function assessment and early intervention may improve morbidity and quality of life in this population.