Role of Ghrelin Level as a Diagnostic Tool for Hypogonadism in Females with Beta Thalassemia Major

Beta thalassemia is an inherited blood disorder characterized by inadequate or absence β-globin chains synthesis. β-thalassemia patients require blood transfusion to survive, but at the same time cause iron deposition in the endocrine glands, liver, and heart. Hypogonadism is the most prevalent endocrine disorder due to iron deposition in the hypothalamus, pituitary, and gonads. Ghrelin, a peptide hormone secreted by the gastric fundus mucosa and plays an important role in the regulation of body weight, energy balance, and reproductive functions. This study aimed to investigate the role of ghrelin level as a diagnostic tool for hypogonadism in females with beta thalassemia major. There were 35 splenectomized thalassemia patients, 35 non-splenectomized thalassemia patients, and 30 healthy controls. Determination of body mass index, red blood cell, hemoglobin, hematocrit, serum ferritin, luteinizing hormone, follicle stimulating hormone, anti mullerian hormone, and ghrelin were performed for all participants. The results showed that BMI, RBC, Hb, Hct, LH, FSH, and AMH levels were significantly lower in both splenectomized and non-splenectomized patients in comparison to healthy controls, whereas serum ferritin level was significantly higher in both splenectomized and non-splenectomized patients in comparison to healthy controls. Ghrelin level was significantly higher in both splenectomized and non-splenectomized patients in comparison to healthy controls, and the area under the receiver operator characteristic curve of ghrelin was high (99.5 %), therefore ghrelin, in addition to serum ferritin, and gonadal hormone analysis can be used as diagnostic tools for assessment of gonadal function, early detection, and prevention of hypogonadism in these patients.