... A common early sign of progressive iron overload is asymptomatic elevation of liver enzyme lev...
A common early sign of progressive iron overload is asymptomatic elevation of liver enzyme levels, particularly alanine aminotransferase (ALT) and aspartate aminotransferase (AST), which later may be accompanied by recurrent right-sided abdominal pain and hepatomegaly. Arthropathy is also common, and occasionally acute episodes of inflammatory arthritis occur, at least some of which are caused by deposits of calcium pyrophosphate dihydrate. Other early signs and symptoms include impotence, amenorrhea, irritability, depression, and fatigue. Because these clinical conditions are not specific to iron overload, the disorder may not be considered in differential diagnosis. Consequently, the underlying cause is not recognized and treated and organ damage progresses.
Liver disease which is present in 30 to 94% of patients with iron overload is the most common complication of hemochromatosis, and cirrhosis is the most common severe sequelae. An autopsy study of patients with cirrhosis showed hemochromatosis as the underlying cause in 7.5% of the deaths. Once cirrhosis is present, risk of liver neoplasm is increased 200 fold in patients with hemochromatosis compared with persons without the disorder, and liver neoplasms account for nearly one third of all deaths among affected patients. Therefore, it is essential that hemochromatosis be considered in the evaluation of any liver abnormality. Other damage to tissues and organs includes gray or bronze skin pigmentation, diabetes mellitus, hypopituitarism, hypogonadism, cardiomyopathy, joint deformity (as arthritis progresses), chronic abdominal pain, and severe fatigue.1 <<<<<<<<<<<<<<<<<<