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Reproductive Hormones and Hypothalamic-Pituitary-Ovarian Axis in Female Patients With Homozygous β-Thalassemia Major

Safarinejad, Mohammad Reza MD

Journal of Pediatric Hematology/Oncology: May 2010 - Volume 32 - Issue 4 - p 259-266
doi: 10.1097/MPH.0b013e3181cf8156
Original Articles

Introduction Homozygous β-thalassemia major (hβ-TM) is an autosomal recessive hemoglobinopathy with prominent endocrine complications. Our aims were to evaluate reproductive hormones, hypothalamic-pituitary-ovarian axis, and fertility in female patients with hβ-TM.

Patients and Methods One hundred forty-four female patients with hβ-TM, aged 18 years or above were enrolled in the study. Seventy-four age-matched healthy female volunteers served as controls. Two blood samples were drawn from each subject at 20-minute intervals for the determination of the resting levels of the following hormones: luteinizing hormone, follicle-stimulating hormone, estradiol, insulin-like growth factor-1, and insulin-like growth factor binding protein-3. The hypothalamic-pituitary-ovarian axis was also assessed using the gonadotropin-releasing hormone test. Menstruation status and growth rate were also noted. Puberty was assessed in both groups by Tanner classification.

Results The mean age of puberty in the control group and hβ-TM patients was 10.8±1.2 and 16.4±2.2 years, respectively (P=0.01). The mean age of menarche was 11.4±1.3 and 16.8±2.1 years in control subjects and patients with thalassemia, respectively (P=0.01). Of studied subjects with hβ-TM, 61 (42.4%) were short in stature (height below the third percentile and below −2 SD scores). The baseline and peak levels of luteinizing hormone, follicle-stimulating hormone, and estradiol after gonadotropin-releasing hormone test in thalassemic group were significantly lower than in the control group.

Conclusions Further interventional studies are warranted to better clarify the treatment options to attain normal puberty and sexual maturation in patients with thalassemia.

Department of Urology, Urology and Nephrology Research Centre, Shahid Beheshti University (MC), Tehran, Iran

Reprints: Mohammad Reza Safarinejad, MD, Urology and Nephrology Research Centre, Shahid Beheshti University (MC), PO Box 19395-1849, Tehran, Iran (e-mail:

Received for publication July 18, 2009; accepted December 12, 2009

Author has no disclosures to report.

Author has no conflict of interest whether of a financial or other nature.

Author did not make any financial arrangement with a company.

Author has no commercial affiliations to report.

© 2010 Lippincott Williams & Wilkins, Inc.