Full Proceeding Paper CORRELATION BETWEEN SERUM FERRITIN, TRANSFERRIN SATURATION AND PITUITARY MRI T2 RELAXATION TIMES AND FSH, LH AND TESTOSTERONE LEVELS IN MALE TRANSFUSION-DEPENDENT THALASSEMIA PATIENTS DIAN ANINDITA LUBIS 1,2* , EM. YUNIR 2 , RAHMAD MULYADI 3 , ANNA MIRA LUBIS 2 , SUKAMTO KOESNOE 2 1,2 Department of Internal Medicine, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia, 3 Department of Radiology, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia Email: dian.anindita@usu.ac.id Received: 05 Oct 2019, Revised and Accepted: 06 Feb 2020 ABSTRACT Objective: The purpose of this study is to see the correlation between iron overload with the hypogonadal state by analyzing the correlation between ferritin serum, transferrin saturation and pituitary MRI T2 relaxation time with FSH, LH and testosterone levels. Methods: This is a cross-sectional study of 32 male subjects with transfusion-dependent thalassemia. The subjects were collected with a consecutive sampling technique in the thalassemia outpatient clinic in National Hospital in Indonesia. Measurements of serum ferritin, transferrin saturation, FSH, LH and testosterone were taken using ELISA technique. Pituitary MRI T2 relaxation time was done using MRI Avanto 1.5 Tesla. Results: In this study, secondary sexual characteristics were not fully achieved in 62.5% of patients. Low testosterone levels were found in 25% of patients. There was a negative correlation between transferrin saturation and pituitary MRI T2 relaxation time in the normal testosterone level group. Conclusion: This study showed a high rate of patients who had not achieve puberty, but a low rate of patients with low testosterone, which means there is a weak negative correlation between transferrin saturation and pituitary MRI T2 relaxation times. Keywords: Hypogonadism, Pituitary MRI T2 relaxation time, Transfusion-dependent thalassemia © 2020 The Authors. Published by Innovare Academic Sciences Pvt Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/) DOI: http://dx.doi.org/10.22159/ijap.2020.v12s3.39464 INTRODUCTION Hypogonadism, a disorder that leads to decreasing testosterone levels in men, may increase the risk of sexual dysfunction, mood disturbances and changes in bone mineral density and body composition [1]. Primary hypogonadism (hypogonadotropic hypogonadism) is indicated with low serum testosterone levels, but high levels of follicle-stimulating hormone (FSH) and luteinizing hormone (LH); while secondary hypogonadism is characterized by low testosterone, FSH and LH levels [2, 3]. Hypogonadism is an endocrinal complication that occurs in 70–80% of major thalassemia patients. In these cases, hypogonadism is caused by iron build-ups in the pituitary gland, testes or both. This disorder is a hereditary condition caused by a defect in globin synthesis, which leads to impaired hemoglobin and requires patients to undergo blood transfusions. Beta-thalassemia is most common in the Mediterranean, Middle East, Asia, India, Southern China, Northern Africa and South America. The highest carrier frequency has been reported in Cyprus (14%), Sardinia (10.3%) and Southeast Asia [4-6]. Thalassemia major patients require regular red blood cell transfusions; this severe type of thalassemia is called transfusion- dependent thalassemia (TDT). Transfusions results in excessive iron accumulation, which can lead to iron toxicity. The examination of blood iron levels is conducted by measuring the transferrin saturation (TSAT) and serum ferritin [4, 7–9]. A radiology technique, Magnetic Resonance Imaging (MRI), has been used and validated in various clinical trials as a useful modality for measuring iron deposits in an organ and has become a new standard for attaining these measurements. The assessment uses MRI T2* in the liver, heart and pancreas. However, due to the small size of the pituitary gland, spin-echo imaging (T2) is likely to perform better than T2* methods [8, 10-12]. Therefore, the aim of this study is to determine the correlation between serum ferritin, transferrin saturation, and excess iron levels in the pituitary gland (assessed by pituitary MRI T2). Along with, the correlation between excess iron levels in the pituitary gland and FSH, LH and testosterone levels in transfusion-dependent thalassemia in the Indonesian population. MATERIALS AND METHODS An analytic cross-sectional method was used in this study. The study was conducted in the adult thalassemia clinic and in the Department of Radiology of National Hospital in Indonesia, in the period of March–July 2019. The samples used were from male transfusion- dependent thalassemia patients aged>18 y of age who were receiving transfusions in the thalassemia clinic during the period of the study. The exclusion criteria included the following: 1. Subjects who experienced drug-induced hyperprolactinemia 2. Subjects with a pituitary tumor 3. Subjects with history of testicular trauma, irradiation or surgery 4. Subjects with history of pituitary surgery Following approval from the Ethics Committee of the Faculty of Medicine in our university, informed consent was obtained from each subject. The convenient sampling technique was used. Based on the correlation test conducted, the minimum number of subjects needed were 32 patients. Data analysis was processed using the SPSS 21.0 program. Results were correlated and statistical analysis was conducted using Pearson’s correlation (r) for normally distributed data, and Spearman’s correlation (rho) test was used for data that was not normally distributed. Patients included in the study were recurring thalassemia patients who were receiving blood transfusions. The diagnosis of thalassemia was previously determined using high-performance liquid chromatography (HPLC) or a microcapillary examination. Plasma concentrations of serum ferritin and transferrin saturation were calculated using mean over a period of 12 mo. Serum ferritin measured using electrochemiluminescence immunoassay (ECLIA) International Journal of Applied Pharmaceutics ISSN- 0975-7058 Vol 12, Special Issue 3, 2020