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Letters to the Editor

Indian Pediatrics 2005; 42:844


We agree entirely with Dr. Banerjee that multitransfused patients of beta thalassemia are susceptible to multiple endocrine dysfunctions of clinical import and hence need comprehensive evaluation. Cost considerations largely dictate the extent of evaluation especially in a country like ours. Regarding serum ACTH levels for diagnosis of secondary adrenal insufficiency, we beg to differ from Dr. Banerjee. A large overlap of ACTH levels, between normal and proven secondary adrenal insufficiency, has been documented in literature(1) and hence the test has limited value. The more discriminant CRH stimulation test is not routinely used in clinical practice because of cost and non-availability. We concur with the views on pituitary MR imaging as an index of iron overload. In addition to T2 relaxation rate, the pituitary to fat signal intensity ratio (P/F) has been used as another marker of iron overload. The degree of reduction of P/F ratio correlates well with presence of hypogonadotropic hypogonadism, with a sensitivity of 90%, specificity of 89% and an overall accuracy of 89%(2).

R.K. Marwaha,
Division of Hematology and Oncology,
Advanced Pediatric Center, PGIMER,
Chandigarh 160 012, India.


1. Grinspoon SK, Biller BMK. Laboratory assessment of adrenal insufficiency. J Clin Endocrinol Metab 1994; 79: 923-931.

2. Sparacia G, Iaia A, Bauco A, D'Angelo P, Lagalla R. Transfusional hemochromatosis - Quantitative relation of MR imaging pituitary signal intensity reduction to hypogonadotropic hypogonadism. Radiology 2000; 215: 818- 823.


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