European Journal of Pediatrics

, Volume 165, Issue 12, pp 897–903

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 Iughetti
  • Annamaria De Bellis
  • Barbara Predieri
  • Antonio Bizzarro
  • Michele De Simone
  • Fiorella Balli
  • Antonio Bellastella
  • Sergio Bernasconi
Original Paper

DOI: 10.1007/s00431-006-0182-4

Cite this article as:
Iughetti, L., De Bellis, A., Predieri, B. et al. Eur J Pediatr (2006) 165: 897. doi:10.1007/s00431-006-0182-4

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 antibodiesCoeliac diseaseGluten-free dietCatch-up growthIdiopathic growth hormone deficiency

Abbreviations

ACTH

Corticotropin

AGA

Antigliadin autoantibodies

APA

Antipituitary autoantibodies

ARA

Antireticulin autoantibodies

BMI

Body mass index

CD

Coeliac disease

E2

Estradiol

EMA

Antiendomysial autoantibodies

FITC

Fluorescein isothiocyanate

FSH

Follicle-stimulating hormone

F-T3

Free triiodothyronine

F-T4

Free thyroxine

GFD

Gluten-free diet

GH

Growth hormone

GHD

Growth hormone deficiency

GHRH

Growth hormone releasing hormone

Ig

Immunoglobulin

IGF-1

Insulin-like growth factor 1

IGF-BP3

IGF-binding protein 3

LH

Luteinising hormone

MRI

Magnetic resonance imaging

PRL

Prolactin

T

Testosterone

T1DM

Type 1 diabetes mellitus

TH

Target height

TSH

Thyroid-stimulating hormone

tTG

Antitransglutaminase autoantibodies

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Lorenzo Iughetti
    • 1
  • Annamaria De Bellis
    • 2
  • Barbara Predieri
    • 1
  • Antonio Bizzarro
    • 3
  • Michele De Simone
    • 4
  • Fiorella Balli
    • 1
  • Antonio Bellastella
    • 2
  • Sergio Bernasconi
    • 5
  1. 1.Department of PediatricsUniversity of Modena and Reggio EmiliaModenaItaly
  2. 2.Department of Clinical and Experimental Medicine and Surgery, Chair of EndocrinologySecond University of NaplesNaplesItaly
  3. 3.Department of Clinical and Experimental Medicine and Surgery, Chair of Immunology and AllergologySecond University of NaplesNaplesItaly
  4. 4.Department of PediatricsUniversity of L’AquilaL’AquilaItaly
  5. 5.Department of PediatricsUniversity of ParmaParmaItaly