Total body iron concentration in normal individuals is 2 to 6 gm. Individuals with HH accumulate iron at a rate of 0.5 to 1.0 gm per year and may exceed total iron concentrations of 50 gm. Symptoms of HH usually develop after 20 gm of iron has accumulated. Thus, men tend to become symptomatic in middle age and women after menopause.
Alcohol can accelerate the effects of iron overload.
Chronic alcoholics can exhibit hepatic fibrosis or cirrhosis almost twice as frequently as non-alcoholic men. The iron deposition associated with chronic alcoholism, however, is typically limited to the liver and not seen extensively in other organs. Iron deposition in major organs, presumably by direct toxic effect, results in cirrhosis, diabetes mellitus, skin pigmentation, polyarthropathy, and hypogonadotrophic hypogonadism. Cardiac involvement may take the form of arrhythmias, restrictive cardiomyopathy, or as in this case, dilated cardiomyopathy. All of these complications, however, are much more commonly seen in persons who do not have HH, so without a family history or iron studies, HH will not be suspected.