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Suggested evaluation for organ damage based on signs and symptoms in patients with iron overload

Suggested evaluation for organ damage based on signs and symptoms in patients with iron overload
Abnormality Indicated evaluations
Weakness, fatigue, malaise Evaluation for liver, endocrinologic, and cardiac disorders and for anemia
Elevated hepatic enzyme concentrations Evaluation for hepatitis B, hepatitis C, and other liver diseases (such as drug-related hepatopathy, alpha-1-antitrypsin deficiency, or metastatic cancer); liver biopsy
Hepatomegaly or hepatic pain Evaluation for hepatitis B, hepatitis C, and other liver diseases; liver biopsy; measurement of alpha-fetoprotein concentration; hepatic imaging procedures; liver MRI*
Arthralgias or arthropathy Radiography of affected joints; evaluation for other arthropathies
Thyroid dysfunction Measurement of thyroid-stimulating hormone, thyroxine, and antithyroid antibody concentration if hypothyroid
Impotence, premature amenorrhea Measurement of luteinizing hormone, follicle-stimulating hormone, and sex hormone concentrations; CT of anterior pituitary to evaluate for possible pituitary tumor
Cardiac symptoms Electrocardiography; echocardiographic assessment of ventricular ejection fraction and exercise tolerance; cardiac MRI*
Hyperglycemia or diabetes mellitus Fasting serum glucose and glycosylated hemoglobin levels
Refer to UpToDate for the approach to the evaluation.
MRI: magnetic resonance imaging; CT: computed tomography.
* Combined liver and heart MRI is available in some institutions.
Adapted from: Barton JC, McDonnell SM, Adams PC. Management of hemochromatosis. Hemochromatosis Management Working Group. Ann Intern Med 1998; 129:932.
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