Introduction. - Hereditary hemochromatosis is a fairly common disease in th
e Caucasian population, with a prevalence estimated at between 1.5 to 3/1,0
00 inhabitants. Over the past few years, its symptomatology has altered at
present, ifs clinical aspect with diabetes mellitus, cirrhosis, and darker
skin pigmentation only constitutes 10% of new cases of this disease.
Current knowledge and key points. - In 1996, the discovery of the C282Y mut
ation in the HFE gene radically altered the diagnostic approach to heredita
ry hemochromatosis. At present, any patient admitted with an isolated case
of asthenia, or with arthralgia or hypertransaminasemia should be examined
via transferrin-saturation testing: if the transferrin saturation coefficie
nt is > 45%, then the presence of the C282Y mutation should be investigated
to confirm the diagnosis of hemochromatosis. A liver biopsy is no longer n
ecessary to establish the diagnosis, but this is still useful in cases of p
ossible cirrhosis, which is the main risk factor for hepatocellular carcino
ma. Phlebotomy remains the sole recommended treatment, and should be undert
aken in a case-specific manner. Family screening should be carried out for
all first-degree relatives for every new case that is diagnosed.
Future prospects and projects. - The discovery of the HFE gene has permitte
d hereditary hemochromatosis to be easily differentiated from other forms o
f hepatic iron overload including a new syndrome, dysmetabolic hepatosidero
sis. Cases of homozygotic C282Y without hepatic iron overload have been des
cribed, but the clinical outcome of some of these cases requires further st
udy, and adds to the controversy on whether systematic population screening
should be made available. (C) 2000 Editions scientifiques et medicales Els
evier SAS.