Serum IGF-1 and short stature in adolescents with β-thalassemia major
Abstract
Background The prevalence of short stature in thalassemia patients ranges from 39.3 to 65%. The cause of short stature is complex and still up for debate. In Indonesia, data on the prevalence and risk factors of short stature in adolescents with thalassemia have been limited.
Objective To assess for the prevalence and risk factors of short stature in adolescents with beta-thalassemia major.
Methods This cross-sectional study was done from February to March 2017 at the Thalassemia Clinic at Dr. Hasan Sadikin General Hospital, Bandung. The baseline characteristics data of 80 adolescents with thalassemia aged 10-14 years were recorded. Short stature was assessed by height-for-age, (Z-score <-2SD) based on the 2007 WHO Reference Growth Chart. Mid-upper arm circumference was scored according to age and sex and serum IGF-1 was measured by ELISA method. Data analyses used were Chi-square, Fisher’s, and Mann-Whitney tests. Logistic regression model was used to further analyze for risk factors of short stature.
Results Subjects were 40 males and 40 females, 81.2% of whom had short stature. The mean serum IGF-1 level was 32.2 (SD 26.38) ng/mL. The IGF-1 cut-off point by ROC curve was ≤38.51 ng/mL, with sensitivity of 64.4% and specificity of 86.7%. The risk factors of short stature were IGF-1 level ≤38.51 ng/mL (PR 40.66; 95%CI 4.37 to 377.58; P<0.001) and low family income (PR 19.76; 95%CI: 1.152 to 256.08; P=0.022).
Conclusion IGF-1 level may be useful as a predictor of short stature in adolescent beta-thalassemia major patients.
References
Shamshirsaz AA, Bekheirnia MR, Kamgar M, Pourzahedgilani N, Bouzari N, Habibzadeh M, et al. Metabolic and endocrinologic complications in beta-thalassemia major: a multicenter study in Tehran. BMC Endocr Disord. 2003;3:4.
Al-Wataify AS. Growth retardation among multi-transfused thalassemic patients in thalassemia center in Babylon Governorate. Med J Babylon. 2012;9:815-23.
Moayeri H, Oloomi Z. Prevalence of growth and puberty failure with respect to growth hormone and gonadotropins secretion in beta-thalassemia major. Arch Iran Med. 2006;9:329-34.
Soliman AT, Khalafallah H, Ashour R. Growth and factors affecting it in thalassemia major. Hemoglobin. 2009;33:S116-26.
Soesanti F, Putriasih SA, Pulungan A, Wahidiyat PA. Endocrinopathies in thalassemia major patients in Thalassemia Center Jakarta, Indonesia. International Journal of Pediatric Endocrinology. 2013;S1:58.
De P, Mistry R, Wright C, Pancham S, Burbridge W, Gangopadhayay K, et al. A review of endocrine disorders in thalassemia. Open J Endocr Metab Dis. 2014;4:25-34.
Ma’ani F, Fadlyana E, Rahayuningsih SE. Hubungan kadar feritin serum dengan fungsi kognitif berdasarkan pemeriksan status mini-mental (MMSE) pada penyandang thalassemia anak. Sari Pediatri. 2015;17:163-8.
Yaman A, Isik P, Yarali N, Karademir S, Cetinkaya S, Bay A, et al. Common complications in beta-thalassemia patients. Int J Hematol Oncol. 2013;23:193-199.
Spiliotis BE. β-Thalassemia and normal growth: are they compatible?. Eur J Endocrinol. 1998;139:143-4.
World Health Organization. Growth reference data for 5-19 years. [cited 2016 July 12]; Available from: http://www.who.int/growthref/en/
Frisancho AR. New norms of upper limb fat and muscle areas for assessment of nutritional status. Am J Clin Nutr. 1981;34:2540-5.
Lemos Pdos S, de Oliveira FL, Caran EM. Nutritional status of children and adolescents at diagnosis of hematological and solid malignancies. Rev Bras Hematol Hemoter. 2014;36:420-3.
Chipkevitch E. Clinical assessment of sexual maturation in adolescent. J Pediatr (Rio J). 2001;77:S135-42.
Pulungan AB. Pubertas dan gangguannya. In: Batubara JRL, Trijaya B, Pulungan AB, editors. 1st ed. Jakarta: Badan Penerbit IDAI; 2010. p. 85-124.
Hashemi AS, Ghilian R, Golestan M, Ghalibaf MA, Zare Z, Dehghani MA. The study of growth in thalassemic patients and its correlation with serum ferritin level. Iran J Pediatr Hematol Oncol. 2011;4:147-51.
Bachtiar IR, Fadil RMR, Azhali M. Hubungan jumlah darah transfusi, pemberian deferoksamin, dan status gizi dengan kadar seng plasma pada penderita thalassemia mayor anak. MKB. 2009;2:1-6.
Kosaryan M, Mojtahedzadeh F, Vahidshahi K, Ehteshami S. The effect of sex steroids on pubertal disorders of beta thalassemia. Int J Med Invest. 2012;1:38-41.
Nasr MR, Ebrahim NA, Ramadan MS, Salahedin O. Growth pattern in children with beta-thalassemia major and its relation with serum ferritin, IGF-1 and IGFBP3. J Clin Exp Invest. 2012;3:157-63.
Ikram N, Hassan K, Younas M, Amanat S. Ferritin levels in patients of beta thalassemia major. Int J Pathol. 2004;2:71-4.
Adil A, Sobani ZA, Jabbar A, Adil SN, Awan S. Endocrine complications in patients of beta thalassemia major in tertiary care hospital in Pakistan. J Pak Med Assoc. 2012;62:307-10.
Ali S, Jahan S. Growth failure in β-thalassemia major patients undergoing repeated transfusions. JIIMC. 2016;11:120-5.
Borgna-Pinatti C, Gamberini MR. Complications of thalassemia major and their treatment. Expert Rev Hematol. 2011;4:353-66.
Pemde HK, Chandra J, Gupta D, Singh V, Sharma R, Dutta AK. Physical growth in children with transfusion-dependent thalassemia. Pediatr Health Med Ther. 2011;2:13-9.
Kyriakou A, Skordis N. Thalassemia and aberrations of growth and puberty. Mediterr J Hematol Infect Dis. 2009;1:e2009003.
Joshi R, Phatarpekar A. Endocrine abnormalities in children with beta thalassaemia major. Sri Lanka J Chidl Helath. 2103;42:81-6.
Fadlyana E, Ma’ani F, Elizabeth M, Reniarti L. Correlation between serum ferritin level and growth disorders in children with thalassemia. Am J Clin Med Res. 2017;5:31-35.
Shalitin S, Carmi D, Weintrob N, Philip M, Miskin H, Kornreich L, et al. Serum ferritin level as a predictor of impaired growth and puberty in thalassemia major patients. Eur J Haematol. 2005;74:93-100.
Shahid N, Bibi F, Usman M, Nasir R, Shah GM, Arshad HM, et al. Role of iron chelation therapy for beta-thalassemia major: a review. J Appl Environ Biol Sci. 2014;4:17-25.
Al-Salehe QA, Al-Awady MS, Abbass SK. Growth retardation in β-thalassemia major. Iraqi Postgrad Med J. 2015;14:267-73.
Coutant R, Dorr H, Gleeson H, Argente J. Diagnosis of endocrine disease: Limitations of the IGF1 generation test in children with short stature. Eur J Endocrinol. 2012;166:351-7.
Alawneh H, Khaledi O, Maita J, Fugaha N, Otoom R, Shatnawi M. Insulin like growth factor 1 as an indicator of growth hormone deficiency. J Royal Med Services. 2015;22:13-7.
Soliman AT, El Banna N, Ansari BM. GH response to provocation and circulating IGF-1 and IGF-binding protein-3 concentrations, the IGF-1 generation test and clinical response to GH therapy in children with β-thalassaemia. Eur J Endocrinol. 1998;138:394-400.
De Sanctis V, Soliman AT, Candini G, Kattamis C, Raiola G, Elsedfy H. Liver iron concentration and liver impairment in relation to serum IGF-1 levels in thalassaemia major patients: a retrospective study. Mediterr J Hematol Infect Dis. 2015;7:e2015015.
Ali A, Hashim R, Khan FA, Sattar A, Ijaz A, Manzoor SM, et al. Evaluation of insulin-like growth factor-1 and insulin like growth factor binding protein-3 in diagnosis of growth hormone deficiency in short-stature children. J Ayub Med Coll Abbottabed. 2009;21:40-5.
Copyright (c) 2018 Monalisa Elizabeth, Eddy Fadlyana, Lelani Reniarti, Faisal Faisal, Hadyana Sukandar, Kusnandi Rusmil
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Authors who publish with this journal agree to the following terms:
Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Accepted 2018-06-28
Published 2018-07-16
