Article
Open Access
Volume 5 · Issue 4 · 2025
pp. 162–166
Endocrine Complications and Their Relationship with Iron Overload in Adult Patients with Sickle Cell Anemia
Ali Alper Solmaz1 
, Anıl Tombak2 , Gülhan Örekici Temel3 , Kerem Sezer4
, Anıl Tombak2 , Gülhan Örekici Temel3 , Kerem Sezer4
1
Department of Medical Oncology, Ministry of Health Adana City Training and Research Hospital, Adana, Türkiye
2
Department of Hematology, Mersin University, Mersin, Türkiye
3
Department of Biostatistics and Medical Informatics, Mersin University, Mersin, Türkiye
4
Department of Endocrinology, Mersin University, Mersin, Türkiye
Abstract
Objectives: The objective of this study was to investigate the prevalence of endocrine complications and to determine their potential relationship with transfusional iron accumulation in adult patients diagnosed with sickle cell anemia (SCA) residing in the Mersin region.
Methods: A retrospective multiparametric study was conducted involving 55 adult patients (aged 18–60 years) fol-lowed at the Mersin University Faculty of Medicine, Adult Hematology Clinic, between July 2018 and July 2019. Com-prehensive clinical and laboratory data were extracted, including hemoglobin variants (HbS, HbF), serum ferritin, and specific endocrine markers such as calcium, phosphorus, 25-OH Vitamin D3, parathormone (PTH), thyroid functions (TSH, sT4, sT3), and gonadotropins (FSH, LH). Glucose metabolism was evaluated through fasting blood glucose, insulin, and HOMA-IR scores. Statistical analysis was performed using descriptive statistics and Chi-square tests to evaluate as-sociations between ferritin levels and biochemical markers, with the threshold for significance set at p<0.05. Results: The study cohort was comprised of 55 patients with a mean age of 32.02±11.97 years, with the female gender representing 41.8% of the population. High rates of metabolic and endocrine abnormalities were identified: Vitamin D deficiency was found in 61.8% of patients, while borderline levels were noted in an additional 23.6%. Furthermore, low corrected calcium was observed in 16.4% and elevated PTH was identified in 12.7% of the cohort. Regarding thyroid function, one patient (1.8%) exhibited low TSH levels, although this individual had a known history of primary hypothy-roidism. In gonadal assessments, FSH and LH levels were elevated in 16.4% and 23.6% of patients, respectively, while no cases of hypogonadotropic hypogonadism were recorded. Glucose metabolism analysis revealed impaired fasting glucose in 18.2% and a HOMA-IR score >3 in 9.1%. No statistically significant association was found between serum fer-ritin levels and endocrine parameters such as ALP (p=0.744), Vitamin D (p=0.505), or TSH (p=0.503).
Conclusion: Although various endocrine complications—particularly those involving bone metabolism and Vitamin D—have been frequently identified in adult SCA patients, these dysfunctions have not been found to correlate with serum ferritin levels in this cohort. This lack of association suggests that factors such as chronic ischemia, micro-infarc-tions, and malperfusion may contribute to endocrine damage in SCA. However, the potential role of iron overload can-not be excluded, particularly given the limitations of ferritin as a surrogate marker. Early and regular screening remains essential for the management of these patients.
Methods: A retrospective multiparametric study was conducted involving 55 adult patients (aged 18–60 years) fol-lowed at the Mersin University Faculty of Medicine, Adult Hematology Clinic, between July 2018 and July 2019. Com-prehensive clinical and laboratory data were extracted, including hemoglobin variants (HbS, HbF), serum ferritin, and specific endocrine markers such as calcium, phosphorus, 25-OH Vitamin D3, parathormone (PTH), thyroid functions (TSH, sT4, sT3), and gonadotropins (FSH, LH). Glucose metabolism was evaluated through fasting blood glucose, insulin, and HOMA-IR scores. Statistical analysis was performed using descriptive statistics and Chi-square tests to evaluate as-sociations between ferritin levels and biochemical markers, with the threshold for significance set at p<0.05. Results: The study cohort was comprised of 55 patients with a mean age of 32.02±11.97 years, with the female gender representing 41.8% of the population. High rates of metabolic and endocrine abnormalities were identified: Vitamin D deficiency was found in 61.8% of patients, while borderline levels were noted in an additional 23.6%. Furthermore, low corrected calcium was observed in 16.4% and elevated PTH was identified in 12.7% of the cohort. Regarding thyroid function, one patient (1.8%) exhibited low TSH levels, although this individual had a known history of primary hypothy-roidism. In gonadal assessments, FSH and LH levels were elevated in 16.4% and 23.6% of patients, respectively, while no cases of hypogonadotropic hypogonadism were recorded. Glucose metabolism analysis revealed impaired fasting glucose in 18.2% and a HOMA-IR score >3 in 9.1%. No statistically significant association was found between serum fer-ritin levels and endocrine parameters such as ALP (p=0.744), Vitamin D (p=0.505), or TSH (p=0.503).
Conclusion: Although various endocrine complications—particularly those involving bone metabolism and Vitamin D—have been frequently identified in adult SCA patients, these dysfunctions have not been found to correlate with serum ferritin levels in this cohort. This lack of association suggests that factors such as chronic ischemia, micro-infarc-tions, and malperfusion may contribute to endocrine damage in SCA. However, the potential role of iron overload can-not be excluded, particularly given the limitations of ferritin as a surrogate marker. Early and regular screening remains essential for the management of these patients.
Keywords: Endocrine Complications, Ferritin, Iron Overload, Sickle Cell Anemia, Vitamin D
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