A middle-aged man presents with congestive hea failure with elevated liver enzymes. His skin has a grayish pigmentation. The levels of liver enzymes are higher than those usually seen in congestive hea failure, suggesting an inflammatory process (hepatitis) with scarring (cirrhosis) of the liver. A liver biopsy discloses a marked increase in iron storage. In humans, molecular iron (Fe) is

Ferrous iron (Fe2+) is the form absorbed in the intestine by ferritin, transpoed in plasma by transferrin, and stored in the liver in combination with ferritin or as hemosiderin. There is no known excretory pathway for iron, either in the ferric or ferrous form. For this reason, excessive iron uptake over a period of many years may cause hemochromatosis, the likely diagnosis for this man. This is a condition of extensive hemosiderin deposition in the liver, myocardium, pancreas, and adrenals. The resulting symptoms include liver cirrhosis, congestive hea failure, diabetes mellitus, and changes in skin pigmentation.