Recognition of zinc-deficiency syndrome

A syndrome occurring in males, characterized by severe iron-deficiency anemia, hypogonadism, dwarfism, hepatosplenomegaly, and geophagia, has been observed in villagers in Iran suffering from malnutrition. Eleven such patients, studied in detail, are described. Despite ht hepatosplenomegaly, results of the liver function tests were uniformly normal except for the serum all;aline phosphatase, which was consistently elevated. The anemia was not associated with blood loss, hookworm infestation, or intestinal malabsorption, and patients responded promptly to oral iron therapy. Although the diet contained adequate amounts of iron, it is believed that the predominantly wheat diet, with its high phosphate content, interfered with absorption because of the formation of insoluble iron complexes. Correction of the anemia resulted in marked decrease in the size of the liver and spleen. Prolonged follow-up of patients receiving a well balanced diet indicates that the endocrine abnormalities of growth and sexual development are reversible. The relationship of geophagia (which occurred in nearly all patients) to this syndrome is not clear and is discussed. The possibility of zinc deficiency is considered as an explanation of hypogonadism, dwarfism, and changes in alkaline phosphatase.