Pancreatic iron overload as a marker of endocrine complications in transfusion‐dependent thalassaemia: A multicentre study

This multicentre cross-sectional study evaluated whether pancreatic iron loading could serve as a reliable biomarker for the identification of endocrine disorders in transfusion-dependent thalassaemia (TDT) patients. A total of 994 adult TDT patients (53.7% female; 39.2 ± 8.3 years) from the Extension-Myocardial Iron Overload in Thalassemia network underwent R2* magnetic resonance imaging to quantify hepatic, pancreatic and cardiac iron. Endocrine disorders (diabetes, hypogonadism, hypothyroidism, hypoparathyroidism and growth hormone deficiency) were diagnosed using standardized clinical criteria. Overall, 60.4% of patients had at least one endocrine disorder. Pancreatic R2* was significantly higher in patients with endocrine disorders compared to those without. Multivariable regression analysis identified age, splenectomy, pancreatic R2* and cardiac R2* as independent predictors of endocrine dysfunction, with a significant interaction between pancreatic and cardiac iron. A pancreatic R2* > 80.86 Hz was the best cut-off for predicting endocrine disorders. Pancreatic R2* remained a significant predictor of endocrine disorders even after excluding diabetic patients. Pancreatic iron increased with endocrine severity, being the highest in patients with multiple endocrinopathies, intermediate in those with a single disorder and the lowest in those without endocrine involvement. Pancreatic iron appears to act as a 'sentinel' marker for extra-hepatic toxicity, supporting its integration into routine risk stratification.