Is growth hormone deficiency contributing to heart failure in patients with beta-thalassemia major?
A 21-year-old woman with beta-thalassemia major (beta-TM) and GH deficiency developed end-stage heart failure, New York Heart Association (NYHA) functional class IV, within 3 months after withdrawal of recombinant human growth hormone (GH). A myocardial biopsy excluded myocarditis and showed moderate iron deposit in the heart. Before her admission, intensified treatments with digoxin, angiotensin-converting enzyme inhibitor, diuretics and extra chelation therapy (desferrioxamine (DFO)) had not improved her progressive heart failure. At admission, GH was reinstituted together with intensified treatment of cardiac drugs and low doses of DFO, and her heart failure reversed. Four months later, NYHA functional class II was reached and within 1 year her cardiac function was normalised. We suggest that GH deficiency due to iron-induced damage to the hypothalamic-pituitary axis can contribute to heart failure in adult patients with beta-TM.
Erfurth
Eva Marie
EM
Department of Endocrinology, Lund University Hospital, Lund, Sweden. Eva_Marie.Erfurth@med.lu.se
Holmer
Helene
H
Nilsson
Per-Gunnar
PG
Kornhall
Bjorn
B
D000328:Adult; D002316:Cardiotonic Agents / Q000627:therapeutic use; D003676:Deferoxamine / Q000627:therapeutic use; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology*; D019382:Human Growth Hormone / Q000172:deficiency*; D006801:Humans; D007502:Iron Chelating Agents / Q000627:therapeutic use; D017086:beta-Thalassemia / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology*
D002316:Cardiotonic Agents; D007502:Iron Chelating Agents; D019382:Human Growth Hormone; D003676:Deferoxamine