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Morbo celiaco ed endocrinopatie autoimmuni: implicazioni diagnostiche e terapeutiche

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Riassunto

Il morbo celiaco (MC) è una malattia autoimmune, presente in soggetti geneticamente predisposti che mostrano una permanente intolleranza al glutine. La malattia si manifesta con disturbi di malassorbimento specifici o aspecifici. Il MC può presentarsi sotto diverse forme: attivo, subclinico e latente. Il modo più idoneo per identificare i soggetti con MC è la ricerca degli anticorpi anti-endomisio o anti-transglutaminasi della classe IgA. La diagnosi, comunque, è possibile solo in seguito al riscontro di alterazioni tipiche nella biopsia intestinale. Il MC si associa a numerose malattie autoimmuni endocrine (tireopatie, diabete mellito di tipo 1, morbo di Addison, sindromi pluriendocrine), nelle quali la frequenza del MC è aumentata rispetto alla popolazione di controllo. Nel presente articolo vengono prese in considerazione le principali interrelazioni tra MC e malattie autoimmuni endocrine e le implicazioni diagnostiche e terapeutiche.

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Bibliografia

  1. Kennedy NP, Feighery C. Clinical features of coeliac disease today. Biomed Pharmacother 54: 373, 2000.

    Article  CAS  PubMed  Google Scholar 

  2. Collin P, Kaukinen K, Valimaki M, Salmi J. Endocrinological disorders and celiac disease. Endocr Rev 23: 464, 2002.

    Article  CAS  PubMed  Google Scholar 

  3. Working Group of European Society of Paediatric Gastroenterology and Nutrition. Revised criteria for diagnosis of coeliac disease. Arch Dis Child 65: 909, 1990.

    Article  Google Scholar 

  4. Trier JS. Review Article. Celiac sprue. N Engl J Med 325: 1709, 1991.

    Article  CAS  PubMed  Google Scholar 

  5. Bottaro G, Cataldo F, Rotolo N, Spina M, Corazza GR. The clinical pattern of sub-clinical/silent celiac disease: an analysis on 1026 consecutive cases. Am J Gastroenterol 94: 691, 1999.

    CAS  PubMed  Google Scholar 

  6. Rewers M, Liu E, Simmons J, Redondo MJ, Hoffenberg EJ. Celiac disease associated with type 1 diabetes mellitus. Endocrinol Metab Clin North Am 33: 197, 2004.

    Article  CAS  PubMed  Google Scholar 

  7. Green PH, Jadri B. Coeliac disease. Lancet 362: 383, 2003.

    Article  CAS  PubMed  Google Scholar 

  8. Collin P, Hakanen M, Salmi J, Maki M, Kaukinen K. Autoimmune hypopituitarism in patients with coeliac disease: symptoms confusingly similar. Scand J Gastroenterol 36: 558, 2001.

    Article  CAS  PubMed  Google Scholar 

  9. Du Castel J. Sur un cas de dermatite polymorphe douloureuse et de Basediwisme associés. Bull Soc Fr Dermat Syph 23: 173, 1912.

    Google Scholar 

  10. Maclaurin BP, Matthews N, Kilpatrikck JA. Coeliac disease associated with autoimmune thyroiditis, Sjogren’s syndrome, and a lymphocytotoxic serum factor. Aust N Z J Med 2: 405, 1972.

    Article  CAS  PubMed  Google Scholar 

  11. Cooper BT, Holmes GK, Cooke WT. Coeliac disease and immunological disorders. BMJ 1: 537, 1978.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  12. Volta U, Bardazzi F, Zauli D, De Franceschi L, Tosti A, Molinaro N, Ghetti S, Tetta C, Grassi A, Bianchi FB. Serological screening for coeliac disease in vitiligo and alopecia areata. Brit J Dermatol 136: 801, 1997.

    Article  CAS  Google Scholar 

  13. Toscano V, Conti FG, Anastasi E, Mariani P, Tiberti C, Poggi M, Montuori M, Monti S, Laureti S, Cipolletta E, Gemme G, Ciola S, Di Mario U, Bonamico M. Importance of gluten in the induction of endocrine autoantibodies and organ dysfunction in adolescent celiac patients. Am J Gastroenterol 95: 1742, 2000.

    Article  CAS  PubMed  Google Scholar 

  14. Ventura A, Neri E, Ughi C, Leopardi A, Citta A, Not T. Gluten-dependent DM-related and thyroid-related autoantibodies in patients with coeliac disease. J Pediatr 137: 263, 2000.

    Article  CAS  PubMed  Google Scholar 

  15. Sategna-Guidetti C, Volta U, Ciacci C, Usai P, Carlino A, De Franceschi L, Camera A, Pelli A, Brossa C. Prevalence of thyroid disorders in untreated adult coeliac disease patients and the effect of gluten withdrawall: an Italian multicenter study. Am J Gastroenterol 96: 751, 2001.

    Article  CAS  PubMed  Google Scholar 

  16. Valentino R, Savastano S, Tommaselli AP, Dorato M, Scarpitta MT, Gigante M, Micillo M, Paparo F, Petrone E, Lombardi G, Troncone R. Prevalence of coeliac disease in patients with thyroid autoimmunity. Horm Res 51: 124, 1999.

    Article  CAS  PubMed  Google Scholar 

  17. Sategna-Guidetti C, Solerio E, Scaglione N, Aimo G, Mengozzi G. Duration of gluten exposure in adult coeliac disease does not correlate with the risk for autoimmune disorders. Gut 49: 502, 2001.

    Article  CAS  PubMed  Google Scholar 

  18. Siurala M, Julkunen H, Lamberg BA. Gastrointestinal tract in hyperthyroidism before and after treatment. Scand J Gastroenterol 1: 79, 1966.

    CAS  PubMed  Google Scholar 

  19. Siurala M, Varis K, Lamberg BA. Intestinal absorption and autoimmunity in endocrine disorders. Acta Med Scand 184: 53, 1968.

    Article  CAS  PubMed  Google Scholar 

  20. Kuitonen P, Maenpaa J, Krohn K, Visakorpi JK. Gastrointestinal findings in autoimmune thyroiditis and non-goitrous juvenile hypothyroidism in children. Scand J Gastroenterol 6: 335, 1971.

    Article  Google Scholar 

  21. Visakorpi JK. Diabetes mellitus and celiac disease. Lancet 2: 1192, 1969.

    Article  Google Scholar 

  22. Crone J, Rami B, Huber WD, Granditsch G, Shober E. Prevalence of celiac disease and follow-up of EMA in children and adolescents with type 1 diabetes mellitus. J Pedr Gastroenterol Nutr 37: 67, 2003.

    Article  CAS  Google Scholar 

  23. Maki M, Hallstrom O, Huupponen T, Vesikari T, Visakorpi JK. Increased prevalence of coeliac disease in diabetes. Arch Dis Child 59: 739, 1984.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  24. Saukkonen T, Savilahti E, Reijonen H, Ilonen J, Tuomilehto-Wolf E, Akerblom HT. Coeliac disease: frequent occurrence after clinical onset of insulin-dependent diabetes mellitus. Diabet Med 13: 464, 1996.

    Article  CAS  PubMed  Google Scholar 

  25. Peretti N, Bienvenu F, Bouvet C, Fabien N, Tixier F, Thivolet C, Levy E, Chatelan G, Lachaux A, Nicolino M. The temporal relationship between the onset of type 1 diabetes and celiac disease: a study based on immunoglobulin A antitransglutaminase screening. Pediatrics 113: 418, 2004.

    Article  Google Scholar 

  26. Spiekerkoetter U, Seissler J, Wendel U. General screening for celiac disease is advisable in children with type 1 diabetes. Horm Metab Res 34: 192, 2002.

    Article  CAS  PubMed  Google Scholar 

  27. Shahbazkhani B, Faezi T, Akbari MR, Mohamadnejad M, Sotoudeh Rajab A, Tahaghoghi S, Malekzadeh R. Coeliac disease in Iranian type I diabetic patients. Dig Liver Dis 36: 191, 2004.

    Article  CAS  PubMed  Google Scholar 

  28. Volta U, Bonazzi C, Pisi E, Salardi S, Cacciari E. Anti-gliadin and anti-reticulin antibodies in coeliac disease and at onset of diabetes in children. Lancet 2: 1034, 1987.

    Article  CAS  PubMed  Google Scholar 

  29. Usai P, Cherchi MV, Boi MF, Cirillo R, Cruz GS, Solinas MP, Frau G, Balestrieri A. Studio della malattia celiaca in corso di diabete mellito insulino dipendente e di diabete insulino indipendente. Recenti Progressi in Medicina 80: 56, 1989.

    CAS  PubMed  Google Scholar 

  30. Barera G, Bianchi C, Calisti L, Cerutti F, Dammacco F, Frezza E, Illeni MT, Mistura L, Pocecco M, Prisco F, Sacchetti C, Saggese G, Stoppoloni G, Tonini G, Chiumello G. Screening of diabetic children for coeliac disease with anti-gliadin antibodies and HLA typing. Arch Dis Child 66: 491, 1991.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  31. Pocecco M, Ventura A. Coeliac disease and insulin-dependent diabetes mellitus: a casual association? Acta Paediatr 84: 1432, 1995.

    Article  CAS  PubMed  Google Scholar 

  32. Lazzarotto F, Basso D, Plebani M, Moscon A, Zanchetta R, Betterle C. Celiac disease and type 1 diabetes. Diabetes Care 26: 248, 2003.

    Article  PubMed  Google Scholar 

  33. Brewer KW, Parziale VS, Eisenbarth GS. Screening patients with insulin-dependent diabetes mellitus for adrenal insufficiency. N Engl J Med 337: 202, 1997.

    Article  CAS  PubMed  Google Scholar 

  34. Catassi C, Natalini G, Ratsch IM, Gabrielli O, Coppa GV, Giorgi PL. Documented latent coeliac disease in a child with insulin-dependent diabetes mellitus. Eur J Pediatr 150: 832, 1991.

    Article  CAS  PubMed  Google Scholar 

  35. Cacciari E, Bianchi FB, Salardi S, Bazzoli F, De Franceschi L, Volta U. Late development of IgA antiendomysial antibodies and small intestinal mucosal atrophy after insulin dependent diabetes mellitus onset. Argh Dis Chil 77: 465, 1997.

    CAS  Google Scholar 

  36. Freemark M, Levitsky LL. Screening for celiac disease in children with type 1 diabetes. Diabetes Care 26: 1932, 2003.

    Article  PubMed  Google Scholar 

  37. Di Mario U, Anastasi E, Mariani P, Ballati G, Perfetti R, Triglione P, Morellini M, Bonamico M. Diabetes-related autoantibodies do appear in children with coeliac disease. Acta Pediatr 81: 593, 1992.

    Article  Google Scholar 

  38. Rapoport MJ, Bistritzer T, Vardi O, Broide E, Azizi A, Vardi P. Increased prevalence of diabetes-related autoantibodies in celiac disease. J Pediatr Gastroenterol Nutr 23: 524, 1996.

    Article  CAS  PubMed  Google Scholar 

  39. Vitoria JC, Castano L, Rica I, Bilbao JR, Arrieta A, Garcia-Masdevall MD. Association of insulin dependent diabetes mellitus and celiac disease: a study based on serological markers. J Pediatr Gastroenterol Nutr 27: 47, 1998.

    Article  CAS  PubMed  Google Scholar 

  40. Galli-Tsinopoulou A, Nousia-Arvanitakis S, Dracoulacos D, Xefteri M, Karamouzis M. Autoantibodies predicting diabetes mellitus type I in celiac diasease. Horm Research 52: 119, 1999.

    Article  CAS  Google Scholar 

  41. Sategna-Guidetti C, Bruno M, Mazza E, Carlino A, Predebon S, Tagliabue M. Clinicopathological conference: a case of adult coeliac disease with Addison’s disease. Br Med J 2: 711, 1970.

    Article  Google Scholar 

  42. Kaukinen K, Collin P, Mykkanen AH, Partanen J, Maki M, Salmi J. Celiac disease and autoimmune endocrinologic disorders. Dig Dis Sci 44: 1428, 1999.

    Article  CAS  PubMed  Google Scholar 

  43. Betterle C, Dal Pra C, Mantero F, Zanchetta R. Autoimmune adrenal insufficiency and autoimmune polyendocrine syndromes: autoantibodies, autoantigens, and their applicability in diagnosis and disease prediction. Endocr Rev 23: 327, 2002.

    Article  CAS  PubMed  Google Scholar 

  44. O’Leary C, Walsh CH, Wieneke P, O’Regan P, Buckley B, O’Hallora DJ, Ferriss JB, Quingley EM, Annis P, Shanahan F, Cronin CC. Coeliac disease and autoimmune Addison’s disease: a clinical pitfall. QJM 95: 79, 2002.

    Article  PubMed  Google Scholar 

  45. Myhre AG, Aarsetoy H, Undlien DE, Hovdenak N, Aksnes L, Huseby ES. High Frequency of coeliac disease among patients with autoimmune adrenocortical failure. Scand J Gastroenterol 38: 511, 2003.

    Article  CAS  PubMed  Google Scholar 

  46. Beressi N, Beressi JP, Cohen R, Modigliani E. Lymphocytic hypophysitis. A review of 145 cases. Ann Med Int 150: 327, 1999.

    CAS  Google Scholar 

  47. Ventura A, Magazzù G, Greco L. Duration of exposure to gluten and risk for autoimmune disorders in patients with coeliac disease. Gastroenterology 117: 297, 1999.

    Article  CAS  PubMed  Google Scholar 

  48. Norris JM, Barriga K, Klingensmith G, Hoffman M, Eisenbarth G, Erlich HA, Rewers M. Timing of initial cereal exposure in infancy and risk of islet autoimmunity. JAMA 290: 1713, 2003.

    Article  CAS  PubMed  Google Scholar 

  49. Hummel M, Bonifacio E, Stern M, Dittler J, Schimmel A, Ziegler AG. Development of celiac disease-associated antibodies in offspring of patients with Type I diabetes. Diabetologia 43: 1005, 2000.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Unità Operativa di Endocrinologia, Università di Padova, Padova, Italia

    Corrado Betterle

  2. Cattedra di Immunologia Clinica, Dipartimento di Scienze Mediche e Chirurgiche, Università di Padova, Padova, Italia

    Corrado Betterle & Francesca Lazzarotto

  3. Dipartimento di Pediatria, Università di Padova, Padova, Italia

    Graziella Guariso

Authors
  1. Corrado Betterle
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  2. Francesca Lazzarotto
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  3. Graziella Guariso
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Correspondence to Corrado Betterle.

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Betterle, C., Lazzarotto, F. & Guariso, G. Morbo celiaco ed endocrinopatie autoimmuni: implicazioni diagnostiche e terapeutiche. L’Endocrinologo 5, 95–103 (2004). https://doi.org/10.1007/BF03344499

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