Endocrine disorders in patients with sickle cell anemia

Red blood cell transfusions are a therapeutic mainstay in Sickle Cell Disease [SCD] and repeated transfusions can result in iron overload. Endocrine dysfunction is the most common and earliest organ toxicity seen in subjects with chronic iron-induced cellular oxidative damage. The aim of the present work is to investigate some of the endocrine functional disorders in patients with SCD. The present study consisted of 30 patients with SCD [proved by hemoglobin electrophoresis from the start of the condition] recruited from the Medical Department of King Fahd Hospital-Hofuf, Eastern Province-Saudi Arabia. Most of the patients had a history of repeated blood transfusions [5 times/year]. Patients were classified into two groups. Group 1 [15 males] and Group 2 [15 females] with mean age for both sex [28.6 +/- 5.4 years]. Thirty age and sex matched normal subjects were, also, included in the study as a control group. Plasma level of testosterone for group 1 and male control group, FSH and LH for group 2 and female control group. Complete blood count, biochemistry, iron profile, as well as thyroid function tests were assessed for both group 1 and 2 and control group. A total of 30 patients with SCD were recruited in the study [15 males and 15 females] with mean age 28.6 +/- 5.4 years. They were compared to a control group of 30 healthy subjects and showed no significant difference between group 1 and the control group regarding the level of testosterone [5.03 +/- 3.37 Vs 6.95 +/- 1.69; respectively, p0.0S]. Also the plasma level of testosterone showed insignificant correlation with the serum iron level among groupi [r=-O.18.p=0.5]. A significant lower level in T4 was detected in group 1 compared to the control group [5.17 +/- 3.41 Vs. 11.01 +/- 1.44; respectively, p=0.001]. There was insignificant correlation between testosterone level in group 1 and the T4 level in the same group [r=-0.Ol, p=0.89]. On the other hand, no significant correlation was detected between group 1 and control group as regard TSH level [p=0.3]. Female patients with SCD [group 2] have a significant lower level of LH than the control group [72 +/- 5.44 Vs. 16.2 +/- 2.74; respectively, p=0.001]. The present study revealed that there was no significant difference between the level of FSH among group 2 and the control group [6.19 +/- 3, 60 Vs. 6.4 +/- 1.3; respectively, p=0.05], as regard the correlation between the LH level and the serum iron among group 2, there was no significant correlation [r=-0.35, p=0.18]. Also group 2 showed significant lower level of the T4 than the control group [6.5 8 +/- 6.3 Vs 11.64 +/- 1.05; respectively, p=0.001]. On the other hand no significant correlation was found between patients in group 2 and control group as regard TSH level p=0.3]. There was no significant correlation between the level of T4 and the serum iron level in both group 1 and group 2 [p=0.5]. The present study had demonstrated that SCD had a depressant effect on the hormone LH in female patients with SCD, and T4 in both males anti females with SCD irrespective of the serum iron level

Endocrine disorders in patients with sickle cell anemia

Red blood cell transfusions are a therapeutic mainstay in Sickle Cell Disease [SCD] and repeated transfusions can result in iron overload. Endocrine dysfunction is the most common and earliest organ toxicity seen in subjects with chronic iron-induced cellular oxidative damage. The aim of the present work is to investigate some of the endocrine functional disorders in patients with SCD. The present study consisted of 30 patients with SCD recruited from the Medical Department of King Fahd Hospital- Hofuf, Eastern Province - Saudi Arabia. Most of the patients had a history of repeated blood transfusions [5 times/year]. Patients were classified into two groups Group I [15 males] and Group 2 [15 females] with mean age for both sex [28.6 +/- 5.4 years]. Thirty age and sex matched normal subjects were, also, included in the study as a control group. Plasma level of testosterone, iron profile, FSH and LH as well as thyroid function tests were assessed. A total of 30 patients with SCD were recruited in the study [15 males and 15 females] with mean age 28.6 +/- 5.4 years. They were compared to a control group of 30 healthy subjects and showed significant difference between group 1 and the control group regarding the level of testosterone [5.03 +/- 3.37 vs 9.65 +/- 1.69; respectively, p=0.05]. Also the level of testosterone showed insignificant correlation with the serum iron level among group 1 [r=-0.18, p=0.5]. A significant lower level in T4 was detected in group 1 compared to the control group [5.17 +/- 3.41 vs 11.01 +/- 1.44; respectively, p=0.001]. There was insignificant correlation between testosterone level in group 1 and the T4 level in the same group [r=-0.01, p=0.89]. On the other hand, no significant difference was detected between group 1 and control group as regard TSH level [p=0.7]. Female patients with SCD [group 2] have a significant lower level of LH than the control group [8.7 +/- 5.44 us 16.2 +/- 2.74; respectively, p=0.001]. The present study revealed that there was no significant difference between the level of FSH among group 2 and the control group [6.19 +/- 3.60 vs 6.4 +/- 1.3; respectively, p=0.8], As regard the correlation between the LH level and the serum iron among group 2, there was no significant correlation [r= -0.35, p =0.18]. Also group 2 showed significant lower level of the T4 than the control group [6.58 +/- 6.3 vs 11.64 +/- 1.05; respectively, p= 0.005]. On the other hand no significant correlation was found between patients and control group as regard TSH level [p=0.1]. There was no significant correlation between the level of T4 and the serum iron level in both group 1 and group 2. The present study has demonstrated that SCD has a depressant effect on the hormone LH in female patients with SCD and T4 in both males and females with SCD irrespective of the serum iron level

Cardiopulmonary compromise during and after gastrointestinal endoscopy

Although gastrointestinal endoscopy is a safe procedure, it is occasionally associated with complications especially in elderly patients or those having heart disease. We studied some cardiopulmonary parameters during and after upper gastrointestinal endoscopy and colonoscopy in patients with and without heart disease in different age groups. Ninety hospitalized patients with age range [46-94 years]; all underwent endoscopy without premedications or conscious sedation. Patients were classified into three groups according to age and risk cardiac index. Electrocardiography with two leads [II, V5] was used; blood pressure and peripheral oxygen saturation [SpO2] were monitored throughout the procedure. Troponin t was evaluated before and 12 hours after the procedure. Relation between changes in cardiopulmonary parameters during and after endoscopy and cardiac function were analyzed. A significant fall was noted in SpO2 during the procedure in group II [92.12 +/- 3.4] and group III [91. 75 +/- 2.4] [P= 0.001] whereas in group I [95 .34 +/- 1.1] no significant fall in SpO2 was noted from the baseline [P=0.63]. A higher cardiac risk index was found in patients with oxygen desaturation than in patients without it [P<0.05]. Atrial and ventricular premature beats found to be significantly higher in old patients and those had underlying heart disease. There is significant increase in systolic blood pressure during insertion of endoscope in all groups with no statistical difference between groups [P=0.5]. ST changes were recorded in three patients with no significant ST level changes between patients with and without heart diseases. Silent ischemia was reported as elevated Troponin t in three patients. Duration of the procedure significantly correlated with oxygen desaturation. Transient cardiopulmonary changes are not uncommon during upper and lower gastrointestinal endoscopy. Patients with ischemic heart disease, chronic pulmonary disease, advanced age, and those undergoing prolonged therapeutic procedures must be considered as high risk patients for the development of cardiopulmonary complications during gastrointestinal endoscopy. Routine use of electronic monitoring with pulse oximetry, ECG recording and blood pressure are important for detecting potentially important abnormalities in high risk groups