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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?

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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.

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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

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Authors and Affiliations

  1. Department of Pediatrics, University of Modena and Reggio Emilia, Via del Pozzo, 71, 41.100, Modena, Italy

    Lorenzo Iughetti, Barbara Predieri & Fiorella Balli

  2. Department of Clinical and Experimental Medicine and Surgery, Chair of Endocrinology, Second University of Naples, 80.131, Naples, Italy

    Annamaria De Bellis & Antonio Bellastella

  3. Department of Clinical and Experimental Medicine and Surgery, Chair of Immunology and Allergology, Second University of Naples, 80.131, Naples, Italy

    Antonio Bizzarro

  4. Department of Pediatrics, University of L’Aquila, 67.100, L’Aquila, Italy

    Michele De Simone

  5. Department of Pediatrics, University of Parma, 43.100, Parma, Italy

    Sergio Bernasconi

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  1. Lorenzo Iughetti
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  2. Annamaria De Bellis
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Correspondence to Lorenzo Iughetti.

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Iughetti, L., De Bellis, A., Predieri, B. et al. 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?. Eur J Pediatr 165, 897–903 (2006). https://doi.org/10.1007/s00431-006-0182-4

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