Abstract
Hemochromatosis is an autosomal recessive genetic disorder that occurs with high prevalence in populations of European origin. The gene that is abnormal in hemochromatosis is found on the short arm of chromosome 6 in close proximity (approximately 1 centimorgan) to HLA-A, but the product coded for by that gene is unknown. The pathogenetic mechanism in hemochromatosis is that of continued, excessive absorption of dietary iron with loss of normal control mechanisms, leading to a gradual but vast expansion of storage iron as ferritin and especially as hemosiderin. Through mechanisms that probably include peroxidation of lipid membranes, the excess iron injures hepatocytes, islet B cells, gonadotropes in the anterior pituitary, myocardium, synovial cells, and chondrocytes, and probably other cells and tissues as well. Most patients with hemochromatosis remain undiagnosed throughout life. Removal of the excess iron by phlebotomy will prevent all of the complications of hemochromatosis when begun early and will significantly improve survival in virtually all patients. It is important, therefore, that the diagnosis of hemochromatosis be considered much more frequently in clinical medicine in order that this effective therapy be utilized.
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Selected References
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- Adams P. C., Halliday J. W., Powell L. W. Early diagnosis and treatment of hemochromatosis. Adv Intern Med. 1989;34:111–126. [PubMed] [Google Scholar]
- Askari A. D., Muir W. A., Rosner I. A., Moskowitz R. W., McLaren G. D., Braun W. E. Arthritis of hemochromatosis. Clinical spectrum, relation to histocompatibility antigens, and effectiveness of early phlebotomy. Am J Med. 1983 Dec;75(6):957–965. doi: 10.1016/0002-9343(83)90875-6. [DOI] [PubMed] [Google Scholar]
- Bacon B. R., Brittenham G. M., Park C. H., Tavill A. S. Lipid peroxidation in experimental hemochromatosis. Ann N Y Acad Sci. 1988;526:155–163. doi: 10.1111/j.1749-6632.1988.tb55502.x. [DOI] [PubMed] [Google Scholar]
- Bassett M. L., Halliday J. W., Bryant S., Dent O., Powell L. W. Screening for hemochromatosis. Ann N Y Acad Sci. 1988;526:274–289. doi: 10.1111/j.1749-6632.1988.tb55512.x. [DOI] [PubMed] [Google Scholar]
- Brittenham G. M. Noninvasive methods for the early detection of hereditary hemochromatosis. Ann N Y Acad Sci. 1988;526:199–208. doi: 10.1111/j.1749-6632.1988.tb55506.x. [DOI] [PubMed] [Google Scholar]
- Cartwright G. E., Edwards C. Q., Kravitz K., Skolnick M., Amos D. B., Johnson A., Buskjaer L. Hereditary hemochromatosis. Phenotypic expression of the disease. N Engl J Med. 1979 Jul 26;301(4):175–179. doi: 10.1056/NEJM197907263010402. [DOI] [PubMed] [Google Scholar]
- Chevrant-Breton J., Simon M., Bourel M., Ferrand B. Cutaneous manifestations of idiopathic hemochromatosis. Study of 100 cases. Arch Dermatol. 1977 Feb;113(2):161–165. [PubMed] [Google Scholar]
- Dabestani A., Child J. S., Perloff J. K., Figueroa W. G., Schelbert H. R., Engel T. R. Cardiac abnormalities in primary hemochromatosis. Ann N Y Acad Sci. 1988;526:234–244. doi: 10.1111/j.1749-6632.1988.tb55509.x. [DOI] [PubMed] [Google Scholar]
- De Sousa M., Breedvelt F., Dynesius-Trentham R., Trentham D., Lum J. Iron, iron-binding proteins and immune system cells. Ann N Y Acad Sci. 1988;526:310–322. doi: 10.1111/j.1749-6632.1988.tb55515.x. [DOI] [PubMed] [Google Scholar]
- Diamond T., Stiel D., Posen S. Osteoporosis in hemochromatosis: iron excess, gonadal deficiency, or other factors? Ann Intern Med. 1989 Mar 15;110(6):430–436. doi: 10.7326/0003-4819-110-6-430. [DOI] [PubMed] [Google Scholar]
- Edwards C. Q., Cartwright G. E., Skolnick M. H., Amos D. B. Homozygosity for hemochromatosis: clinical manifestations. Ann Intern Med. 1980 Oct;93(4):519–525. doi: 10.7326/0003-4819-93-4-519. [DOI] [PubMed] [Google Scholar]
- Edwards C. Q., Griffen L. M., Goldgar D., Drummond C., Skolnick M. H., Kushner J. P. Prevalence of hemochromatosis among 11,065 presumably healthy blood donors. N Engl J Med. 1988 May 26;318(21):1355–1362. doi: 10.1056/NEJM198805263182103. [DOI] [PubMed] [Google Scholar]
- Edwards C. Q., Griffen L. M., Skolnick M. H., Kushner J. P. Sporadic porphyria cutanea tarda in individuals with HLA-linked hemochromatosis allele(s). Preliminary report. Ann N Y Acad Sci. 1988;526:47–53. doi: 10.1111/j.1749-6632.1988.tb55491.x. [DOI] [PubMed] [Google Scholar]
- FINCH S. C., FINCH C. A. Idiopathic hemochromatosis, an iron storage disease. A. Iron metabolism in hemochromatosis. Medicine (Baltimore) 1955 Dec;34(4):381–430. doi: 10.1097/00005792-195512000-00001. [DOI] [PubMed] [Google Scholar]
- Flanagan P. R., Lam D., Banerjee D., Valberg L. S. Ferritin release by mononuclear cells in hereditary hemochromatosis. J Lab Clin Med. 1989 Feb;113(2):145–150. [PubMed] [Google Scholar]
- Fujisawa I., Morikawa M., Nakano Y., Konishi J. Hemochromatosis of the pituitary gland: MR imaging. Radiology. 1988 Jul;168(1):213–214. doi: 10.1148/radiology.168.1.3380960. [DOI] [PubMed] [Google Scholar]
- Green R., Esparza I., Schreiber R. Iron inhibits the nonspecific tumoricidal activity of macrophages. A possible contributory mechanism for neoplasia in hemochromatosis. Ann N Y Acad Sci. 1988;526:301–309. doi: 10.1111/j.1749-6632.1988.tb55514.x. [DOI] [PubMed] [Google Scholar]
- Hallberg L., Björn-Rasmussen E., Jungner I. Prevalence of hereditary haemochromatosis in two Swedish urban areas. J Intern Med. 1989 Apr;225(4):249–255. doi: 10.1111/j.1365-2796.1989.tb00074.x. [DOI] [PubMed] [Google Scholar]
- Jones H. R., Jr, Hedley-Whyte E. T. Idiopathic hemochromatosis (IHC): dementia and ataxia as presenting signs. Neurology. 1983 Nov;33(11):1479–1483. doi: 10.1212/wnl.33.11.1479. [DOI] [PubMed] [Google Scholar]
- Kaplan J., Craven C., Alexander J., Kushner J., Lamb J., Bernstein S. Regulation of the distribution of tissue iron. Lessons learned from the hypotransferrinemic mouse. Ann N Y Acad Sci. 1988;526:124–135. doi: 10.1111/j.1749-6632.1988.tb55498.x. [DOI] [PubMed] [Google Scholar]
- Kelly T. M., Edwards C. Q., Meikle A. W., Kushner J. P. Hypogonadism in hemochromatosis: reversal with iron depletion. Ann Intern Med. 1984 Nov;101(5):629–632. doi: 10.7326/0003-4819-101-5-629. [DOI] [PubMed] [Google Scholar]
- LeSage G. D., Baldus W. P., Fairbanks V. F., Baggenstoss A. H., McCall J. T., Moore S. B., Taswell H. F., Gordon H. Hemochromatosis: genetic or alcohol-induced? Gastroenterology. 1983 Jun;84(6):1471–1477. [PubMed] [Google Scholar]
- Mak I. T., Weglicki W. B. Characterization of iron-mediated peroxidative injury in isolated hepatic lysosomes. J Clin Invest. 1985 Jan;75(1):58–63. doi: 10.1172/JCI111697. [DOI] [PMC free article] [PubMed] [Google Scholar]
- McLaren G. D. Reticuloendothelial iron stores and hereditary hemochromatosis: a paradox. J Lab Clin Med. 1989 Feb;113(2):137–138. [PubMed] [Google Scholar]
- McNeil L. W., McKee L. C., Jr, Lorber D., Rabin D. The endocrine manifestations of hemochromatosis. Am J Med Sci. 1983 May-Jun;285(3):7–13. doi: 10.1097/00000441-198305000-00002. [DOI] [PubMed] [Google Scholar]
- Milder M. S., Cook J. D., Stray S., Finch C. A. Idiopathic hemochromatosis, an interim report. Medicine (Baltimore) 1980 Jan;59(1):34–49. doi: 10.1097/00005792-198001000-00002. [DOI] [PubMed] [Google Scholar]
- Monaco A. P., Kunkel L. M. Cloning of the Duchenne/Becker muscular dystrophy locus. Adv Hum Genet. 1988;17:61–98. doi: 10.1007/978-1-4613-0987-1_3. [DOI] [PubMed] [Google Scholar]
- Morgan E. H., Baker E. Role of transferrin receptors and endocytosis in iron uptake by hepatic and erythroid cells. Ann N Y Acad Sci. 1988;526:65–82. doi: 10.1111/j.1749-6632.1988.tb55493.x. [DOI] [PubMed] [Google Scholar]
- Niederau C., Fischer R., Sonnenberg A., Stremmel W., Trampisch H. J., Strohmeyer G. Survival and causes of death in cirrhotic and in noncirrhotic patients with primary hemochromatosis. N Engl J Med. 1985 Nov 14;313(20):1256–1262. doi: 10.1056/NEJM198511143132004. [DOI] [PubMed] [Google Scholar]
- Olson L. J., Baldus W. P., Tajik A. J. Echocardiographic features of idiopathic hemochromatosis. Am J Cardiol. 1987 Oct 1;60(10):885–889. doi: 10.1016/0002-9149(87)91041-1. [DOI] [PubMed] [Google Scholar]
- Olson L. J., Edwards W. D., Holmes D. R., Jr, Miller F. A., Jr, Nordstrom L. A., Baldus W. P. Endomyocardial biopsy in hemochromatosis: clinicopathologic correlates in six cases. J Am Coll Cardiol. 1989 Jan;13(1):116–120. doi: 10.1016/0735-1097(89)90558-5. [DOI] [PubMed] [Google Scholar]
- Peters T. J., Raja K. B., Simpson R. J., Snape S. Mechanisms and regulation of intestinal iron absorption. Ann N Y Acad Sci. 1988;526:141–147. doi: 10.1111/j.1749-6632.1988.tb55500.x. [DOI] [PubMed] [Google Scholar]
- Rahier J., Loozen S., Goebbels R. M., Abrahem M. The haemochromatotic human pancreas: a quantitative immunohistochemical and ultrastructural study. Diabetologia. 1987 Jan;30(1):5–12. doi: 10.1007/BF01788899. [DOI] [PubMed] [Google Scholar]
- Robins-Browne R. M., Prpic J. K. Effects of iron and desferrioxamine on infections with Yersinia enterocolitica. Infect Immun. 1985 Mar;47(3):774–779. doi: 10.1128/iai.47.3.774-779.1985. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Rouault T. A., Hentze M. W., Caughman S. W., Harford J. B., Klausner R. D. Binding of a cytosolic protein to the iron-responsive element of human ferritin messenger RNA. Science. 1988 Sep 2;241(4870):1207–1210. doi: 10.1126/science.3413484. [DOI] [PubMed] [Google Scholar]
- Schumacher H. R., Straka P. C., Krikker M. A., Dudley A. T. The arthropathy of hemochromatosis. Recent studies. Ann N Y Acad Sci. 1988;526:224–233. doi: 10.1111/j.1749-6632.1988.tb55508.x. [DOI] [PubMed] [Google Scholar]
- Simon M., Pawlotsky Y., Bourel M., Fauchet R., Genetet B. Hémochromatose idiopathique Maladie associée à l'antigène tissulaire HL-A 3. Nouv Presse Med. 1975 May 10;4(19):1432–1432. [PubMed] [Google Scholar]
- Simon M., Yaouanq J., Fauchet R., Le Gall J. Y., Brissot P., Bourel M. Genetics of hemochromatosis: HLA association and mode of inheritance. Ann N Y Acad Sci. 1988;526:11–22. doi: 10.1111/j.1749-6632.1988.tb55488.x. [DOI] [PubMed] [Google Scholar]
- Stark D. D., Moseley M. E., Bacon B. R., Moss A. A., Goldberg H. I., Bass N. M., James T. L. Magnetic resonance imaging and spectroscopy of hepatic iron overload. Radiology. 1985 Jan;154(1):137–142. doi: 10.1148/radiology.154.1.3964933. [DOI] [PubMed] [Google Scholar]
- Stevens R. G., Jones D. Y., Micozzi M. S., Taylor P. R. Body iron stores and the risk of cancer. N Engl J Med. 1988 Oct 20;319(16):1047–1052. doi: 10.1056/NEJM198810203191603. [DOI] [PubMed] [Google Scholar]
- Stremmel W., Niederau C., Berger M., Kley H. K., Krüskemper H. L., Strohmeyer G. Abnormalities in estrogen, androgen, and insulin metabolism in idiopathic hemochromatosis. Ann N Y Acad Sci. 1988;526:209–223. doi: 10.1111/j.1749-6632.1988.tb55507.x. [DOI] [PubMed] [Google Scholar]
- Strohmeyer G., Niederau C., Stremmel W. Survival and causes of death in hemochromatosis. Observations in 163 patients. Ann N Y Acad Sci. 1988;526:245–257. doi: 10.1111/j.1749-6632.1988.tb55510.x. [DOI] [PubMed] [Google Scholar]
- Thalassemia major: molecular and clinical aspects. NIH Conference. Ann Intern Med. 1979 Dec;91(6):883–897. doi: 10.7326/0003-4819-91-6-883. [DOI] [PubMed] [Google Scholar]
- Tiniakos G., Williams R. Cirrhotic process, liver cell carcinoma and extrahepatic malignant tumors in idiopathic haemochromatosis. Study of 71 patients treated with venesection therapy. Appl Pathol. 1988;6(2):128–138. [PubMed] [Google Scholar]
- Weinberg E. D. Iron withholding: a defense against infection and neoplasia. Physiol Rev. 1984 Jan;64(1):65–102. doi: 10.1152/physrev.1984.64.1.65. [DOI] [PubMed] [Google Scholar]
- Whittaker P., Skikne B. S., Covell A. M., Flowers C., Cooke A., Lynch S. R., Cook J. D. Duodenal iron proteins in idiopathic hemochromatosis. J Clin Invest. 1989 Jan;83(1):261–267. doi: 10.1172/JCI113868. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Wright A. C., Simpson L. M., Oliver J. D. Role of iron in the pathogenesis of Vibrio vulnificus infections. Infect Immun. 1981 Nov;34(2):503–507. doi: 10.1128/iai.34.2.503-507.1981. [DOI] [PMC free article] [PubMed] [Google Scholar]