Original Paper

European Journal of Pediatrics

, Volume 165, Issue 12, pp 897-903

First online:

Growth hormone impaired secretion and antipituitary antibodies in patients with coeliac disease and poor catch-up growth after a long gluten-free diet period: a causal association?

  • Lorenzo IughettiAffiliated withDepartment of Pediatrics, University of Modena and Reggio Emilia Email author 
  • , Annamaria De BellisAffiliated withDepartment of Clinical and Experimental Medicine and Surgery, Chair of Endocrinology, Second University of Naples
  • , Barbara PredieriAffiliated withDepartment of Pediatrics, University of Modena and Reggio Emilia
  • , Antonio BizzarroAffiliated withDepartment of Clinical and Experimental Medicine and Surgery, Chair of Immunology and Allergology, Second University of Naples
  • , Michele De SimoneAffiliated withDepartment of Pediatrics, University of L’Aquila
  • , Fiorella BalliAffiliated withDepartment of Pediatrics, University of Modena and Reggio Emilia
  • , Antonio BellastellaAffiliated withDepartment of Clinical and Experimental Medicine and Surgery, Chair of Endocrinology, Second University of Naples
  • , Sergio BernasconiAffiliated withDepartment of Pediatrics, University of Parma

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Abstract

Introduction

Coeliac disease (CD) is usually associated with impaired growth in children. A gluten-free diet (GFD) induces a catch-up growth with the recovery of height in about 2 years.

Aim and discussion

The lack of the height improvement has been related to growth hormone (GH) secretion impairment. CD is an autoimmune disease often associated with other endocrine and non-endocrine autoimmune disease. The aim of this study was to evaluate antipituitary autoantibodies (APA) and antihypothalamus autoantibodies in CD children with poor clinical response to a GFD and growth hormone deficiency (GHD). We diagnosed CD on the basis of specific antibodies and endoscopic biopsies in 130 patients aged 1–15 years. Seven CD children, without catch-up growth after at least 12-months GFD, were tested for GH secretion and, in five out of seven patients, the diagnosis of GHD was made in the absence of metabolic and systemic diseases.

Results

APA and antihypothalamus antibodies were detected by the indirect immunofluorescence method in the seven CD children without catch-up growth factor and in 25 CD children without growth impairment matched for sex and age, and in 58 healthy children as control groups. APA resulted positive at high titres in four out of five CD-GHD patients and were also positive at low titres (<1:8) in three of only CD children and in two out of 58 controls. Hypothalamic-pituitary magnetic resonance imaging (MRI) was normal in all patients except in one with cystic pineal. APA have been previously detected not only in adults with GHD, but also in idiopathic GHD children, suggesting the occurrence of an autoimmune hypophysitis in these patients.

Conclusion

In our study, the presence of APA in CD children without catch-up growth after GFD seems to be able to identify an autoimmune form of hypophysitis involving the somatotrophs cells.

Keywords

Antipituitary antibodies Coeliac disease Gluten-free diet Catch-up growth Idiopathic growth hormone deficiency