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General Clinical Considerations

HH is frequently discovered only during management of associated illness or routine health evaluations. It has been estimated that only a small percentage of all affected persons are actually diagnosed. Individuals with HH may be symptomatic for several years prior to diagnosis and may have consulted multiple health care providers.
Under-diagnosis of HH is thought to occur due to:
• Lack of specificity of early signs and symptoms
• Asymptomatic status of some patients until damage to organs and tissues has occurred
• Confusion with liver disease due to other causes
• Insufficient awareness and knowledge of HH

Early identification of persons with HH is essential to prevent serious and irreversible complications associated with severe iron overload. A classic triad of skin hyperpigmentation (bronzing), type 2 diabetes, and hepatic cirrhosis has long been recognized as evidence of advanced iron overload. However, persons with HH may present with a much wider variety of signs and symptoms, particularly if they are seen before significant iron accumulation has occurred.
Age of presentation and disease severity are highly variable.