Iron Overload and Organ Damage
Organ damage is one of the most serious complications of iron overload that can occur in the undiagnosed patient. The organs that may be affected are the liver, heart, pancreas and endocrine glands. Major complications that sometimes arise from haemochromatosis include:
Liver Disorders:
Fibrosis; cirrhosis; hepatocellular carcinoma (cancer) and portal hypertension.
Joint and bone problems:
Osteoarthritis; synovitis (the painful swelling of a joint); osteonecrosis; chondrocalcinosis; osteoporosis.
Heart problems:
Various types of cardiomyopathy (heart failure) and cardiomegaly conditions occur. These include cardiac arrythmias (irregularities of the heart beat) and ventricular dysfunction. These conditions usually occur in the younger person when iron levels are grossly elevated over a prolonged period of time. Echocardiography in early stages of the disorder can detect the presence of inter-ventricular septal thickness that reflects iron deposition.
Some improvement in these conditions usually occurs when iron stores are reduced.
Skin colouration and conditions:
Bronze pigmentation occurs because iron builds up within and around the sweat glands. This causes an increase in iron in the epidermis. If the sweat glands are affected it can cause heavy, dark staining with a particular colour. Old scars can be highly pigmented, and the conjunctiva and lid of the eye can be coloured. If the skin is heavily affected it can be a slate grey in colour. Fine skin is noted with diminished facial, pubic and axillary hair. There can be dryness associated with itchiness to varying degrees.
Diabetes mellitus:
Diabetes secondary to haemochromatosis is caused by or associated with the deposition of iron in the liver and the pancreas. This can lead to insulin resistance and glucose intolerance and to degenerative to the cells in the pancreas responsible for production insulin.
Hypogonadism (diminished sexual function):
This can cause reduced sex drive, cessation of menstruation (periods) in women and impotence in men.
Hypothyroidism:
Iron affects the thyroid gland and causes hypothyroidism, which slows down the body processes. Weight gain and tiredness are some of the signs of this problem if tiredness is persistent after removal of iron this disorder should be considered. Treatment for these problems varies and can include hormone replacement therapy.
Abdominal pain:
Abdominal pain is a frequent complaint and may described as an aching to a moderate pain sensation. The abdominal pain is located in the right upper quadrant, just above the stomach. Chest and back are occasionally also sites of pain. Often no cause is found or it can be related to liver damage.
Mood swings, systemic / non-specific problems, fatigue, malaise, weakness:
Most of these symptoms are found in other disorders. Chronic fatigue may be ascribed to after-effects of a viral infection or to psychological causes, and abdominal pain to irritable bowel syndrome. Similarly liver disorders may be put down to excessive alcohol intake, even in someone who is only a moderate drinker. However, if the same symptoms are present, GH. should also be considered as a diagnosis.
Most individuals who have GH. will, in due course, develop at least one or two of the above symptoms, although possibly in a milder form. There may be a long phase of the condition where there are no symptoms. However, if arthritis is found only in the first two finger joints this is highly suggestive of GH.
The need of treatment to remove excess iron does not depend upon the present of clinical symptoms. The risk of development of a serious complaint such as cirrhosis is much too great to be overlooked.
