Demir ve Endokrin Sisteme Olan Etkileri
Özet
Demir, DNA sentezi ve oksijen taşınması gibi temel metabolik süreçlerin düzenlenmesinde hayati öneme sahip bir elementtir. Metabolizması sıkı kontrol altında tutulmasına rağmen, herediter hemokromatozis veya tekrarlayan kan transfüzyonları gibi durumlarda vücutta aşırı demir birikimi meydana gelebilir. Bu birikim, başta endokrin bezler olmak üzere çeşitli organlarda hasara yol açabilir. Bu hasarın temel nedeni, aşırı miktarda üretilen reaktif oksijen türlerinin oluşturduğu oksidatif strestir. Beta-talasemi major (BTM) pankreasta demir birikimi nedeniyle bozulmuş glukoz metabolizması, glukoz intoleransı ve diabetes mellitus ile ilişkilendirilmiştir. Demirin aşırı birikiminde azalmış insülin sekresyonu, artmış insülin direnci ve karaciğerde artmış glukoneogenez görülür. Hipofizde demir birikimi, gonadotropinlerin salınımını bozarak en yaygın bozukluk olan hipogonadizme ve büyüme hormon eksikliğine bağlı büyüme geriliğine neden olabilir. BTM'de artan demir yükü hipotiroidizme, hipoparatiroidizme ve adrenal yetmezliğe de neden olabilir. BTM'li hastalarda bu endokrin bozuklukların bir sonucu olarak osteoporoz görülebilir. Öte yandan demir eksikliği obezite, diabetes mellitus, etkisiz termogeneze neden olabilir. Demir eksikliği, tiroid peroksidaz enzim biyosentezindeki bozulmalar nedeniyle hipotiroidizmle de ilişkilendirilmektedir.
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