Dr Ruchi Parikh

Endocrinopathies are associated with Thalassemia due to iron overload in endocrine glands which include pituitary gland, thyroid gland, parathyroid gland, pancreas, adrenal gland, bones, ovary and testis. Acute and late endocrine problems (poor growth, thyroid dysfunction, pubertal and menstrual issues, osteoporosis, obesity, blood glucose abnormalities) are seen in cancer patients due to the effect of cancer itself or its treatment of chemotherapy and radiotherapy and in patients undergoing bone marrow transplantation. Hence long-term care for all such patients should include surveillance for endocrine complications.

Endocrinology services are provided as outpatient clinics which are held twice a week (days). All patients with Thalassemia are clinically assessed for growth parameters (weight, height and body mass index) using appropriate weighing scales and stadiometer. They are examined for the onset and progression of puberty. Regular/annual lab assessment of Blood sugar, Thyroid, Pubertal, Adrenal and Bone profiles are carried out.

Also, patients undergoing chemotherapy /radiation and pre/post bone marrow transplantation (BMT), screening for endocrine complications is carried out on regular basis. Patients and parents are counseled the importance of assessment of long-term endocrine effects and explained in detail the treatment if needed. Dynamic study protocols such as Growth Hormone stimulation test, Synacthen test, Blood Glucose profiles etc. are in place and are well coordinated at the centre.

Treatment in the form of hormone replacement therapy for thyroid disorder, delayed puberty, adrenal insufficiency, hypocalcaemia and osteopenia/osteoporosis has ensured optimum growth, puberty and quality of lifestyle in these patients. For patients with Diabetes Mellitus, diabetes education program is in place which guides them for Insulin therapy, nutritional advice, monitoring of blood sugars to achieve the target glycemic range, management of abnormal blood sugars and regular assessment for complications. Patients are treated as inpatients for acute complications related to management of hematology-oncology disorders such as hyperglycemia, hypoglycemia and hypocalcaemia.

Multidisciplinary clinics are conducted with other specialties as needed (Gynecology, Pediatric Surgery, Pediatric Nephrology and Pediatric Gastroenterology).