Delayed adrenache in thalassaemia: a case series

Thalassemia major is a transfusion dependent genetically inherited haematological disorder that could lead to multiple endocrinopathies due to the chronic hypoxia and iron over load that is associated with this condition. Delayed adrenarche and thalassemia major is not commonly described. However, when it occurs, it is a condition of significant concern among affected individuals. We observed a significant delay in adrenarche compared to other secondary sexual characteristic changes that occurs during puberty among adolescents with thalassemia major. Coinciding with the clinical picture, dissociation in cortisol and adrenal androgen secretion was also noted. Chronic hypoxia, low body mass index and zinc deficiency associated with thalassemia major are thought to be the possible explanation for these observations. These observations raise the need for proper studies to identify the aetiology and the possible mechanisms of treating this clinical entity.