Numerous clinical entities have now been identified to cause pathologic
iron accumulation in the liver. Some are well described and have a verified hereditary basis; in others the genetic basis is still speculative, while in several cases nongenetic
iron-loading factors are apparent. The non- HFE
hemochromatosis syndromes identifies a subgroup of hereditary
iron loading disorders that share with classic HFE-
hemochromatosis, the autosomal recessive trait, the pathogenic basis (i.e., lack of
hepcidin synthesis or activity), and key clinical features. Yet, they are caused by pathogenic mutations in other genes, such as
transferrin receptor 2 ( TFR2),
hepcidin ( HAMP), hemojuvelin ( HJV) , and
ferroportin ( FPN), and, unlike HFE-
hemochromatosis, are not restricted to Caucasians.
Ferroportin disease, the most common non- HFE hereditary
iron-loading disorder, is caused by a loss of
iron export function of FPN resulting in early and preferential
iron accumulation in Kupffer cells and macrophages with high
ferritin levels and low-to-normal
transferrin saturation. This autosomal dominant disorder has milder expressivity than
hemochromatosis. Other much rarer
genetic disorders are associated with hepatic
iron load, but the clinical picture is usually dominated by symptoms and signs due to failure of other organs (e.g.,
anemia in
atransferrinemia or neurologic defects in
aceruloplasminemia). Finally, in the context of various necro-inflammatory or disease processes (i.e., chronic viral or metabolic
liver diseases), regional or local
iron accumulation may occur that aggravates the
clinical course of the underlying disease or limits efficacy of
therapy.