A patient with repeated transfusions may develop black hypopituitarism from iron overload.
Clinical features:
(1) thalassemia major or other chronic anemia
(2) transfusion dependent
(3) not receiving chelation therapy to mobilize excess iron
(4) hypopituitarism
The pituitary becomes dark in color as the more iron accumulates.
Hypopituitarism may involve:
(1) hypogonadotropic hypogonadism, which may be associated with failure to undergo puberty
(2) growth hormone deficiency with short stature
Laboratory findings:
(1) serum ferritin > 2000 micrograms per L
(2) elevated serum iron
(3) high transferrin saturation
T2-weighted MRI can demonstrate the excess iron in the pituitary and other organs.
