Gastrointestinal Manifestations of Endocrine Disease

  • Naushira PandyaEmail author
  • Elizabeth Hames
Living reference work entry


There are many complex interactions between the central and autonomic nervous systems and hypothalamus, pituitary, thyroid, parathyroid, and enteroendocrine cells in target gastrointestinal (GI) organs, which regulate food intake, metabolism, and GI motility. Current knowledge of hormonal influences between these different body systems is limited.

Dysregulation of the thyroid gland can cause multiple effects on the upper and lower GI tract, the most common being abnormal intestinal motility (motor function) and transit time. Hyperparathyroidism can produce multiple manifestations including heartburn, nausea, abdominal pain, pancreatitis, and constipation as the most common manifestations.

The most frequent complications of diabetes affecting the GI tract are gastroparesis and disturbance of pancreatic function. However, diabetes can also exacerbate existing periodontal disease and gastroesophageal disease. Celiac disease, hepatic microangiopathy, autoimmune gastritis, and the increased incidence of certain tumors (linked to insulin resistance) may also be regarded as long-term complications of diabetes.

Adrenal insufficiency may be associated with nausea, anorexia, diarrhea, and abdominal pain and requires a high index of suspicion if no immediate cause for these symptoms is identified. Cushing’s syndrome may be a component of multiple endocrine neoplasia syndrome 1 (MEN 1), along with the Zollinger-Ellison syndrome which manifests as recurrent peptic ulcers.

Endocrine disease may present with vague symptoms, particularly in older adults with age-related physiologic changes of the gastrointestinal (GI) tract and geriatric syndromes (frailty, sarcopenia, weight loss, and dementia). Underlying endocrine disease must be considered in the differential diagnosis, allowing for timely recognition and treatment.


Autonomic neuropathy Thyroid dysfunction Endocrine pharmacology Geriatric endocrinology Hyperparathyroidism Cushing’s syndrome Zollinger-Ellison syndrome Multiple endocrine neoplasia Diarrhea Constipation Abdominal pain Pituitary-gut axis Gastroendocrine Neuroendocrine system Gastrointestinal manifestations of endocrine disease 


  1. Abboud B, et al. Digestive manifestations of parathyroid disorders. World J Gastroenterol. 2011;17:4063–6.PubMedPubMedCentralCrossRefGoogle Scholar
  2. Almogbel RA, Alhussan FA, Alnasser SA. Prevalence and risk factors of gastroparesis-related symptoms among patients with type 2 diabetes. Int J Health Sci (Qassim). 2016;10(3):397–404.CrossRefGoogle Scholar
  3. American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association (AGA) Institute, American Society for Gastrointestinal Endoscopy, Waxler A. The gastroenterology core curriculum. 3rd ed. Gastroenterology 2007;132:2012–18.Google Scholar
  4. Bancos I, Hahner S, Tomlinson J, et al. The Lancet Diabetes and Endocrinology. 2015;3(3):216–226.Google Scholar
  5. Banks PA, Freeman ML. Practice guidelines in acute pancreatitis. Am J Gastroenterol. 2006;101:2379–400.PubMedCrossRefGoogle Scholar
  6. Bettge K, Kahle M, Abd El Aziz MS, et al. Occurrence of nausea, vomiting and diarrhoea reported as adverse events in clinical trials studying glucagon-like peptide-1 receptor agonists: a systematic analysis of published clinical trials. Diabetes Obes Metab. 2017;19(3):336–47.PubMedCrossRefGoogle Scholar
  7. Bharucha AE, Kudva YC, Prichard DO. Diabetic gastroparesis. Endocr Rev. 2019; Scholar
  8. Bhatt H, Smith RJ. Fatty liver disease in diabetes mellitus. Hepatobiliary Surg Nutr. 2015;4(2):101–8.PubMedPubMedCentralGoogle Scholar
  9. Ch’ng CL, et al. Prospective screening for celiac disease in patients with graves’ hyperthyroidism using anti-gliadin and tissue transglutaminase antibodies. Clin Endocrinol. 2005;62:303–6.CrossRefGoogle Scholar
  10. Chiu, et al. Dysphagia as a manifestation of thyrotoxicosis: report of three cases and literature review. Dysphagia. 2004;19:120–4.PubMedGoogle Scholar
  11. Ciobanu L, Dumitrascu DL. Gastrointestinal motility disorders in endocrine diseases. Pol Arch Med Wewn. 2011;121:129–36.PubMedGoogle Scholar
  12. Daher R, et al. Consequences of Dysthyroidism on the digestive tract and viscera. World J Gastroenterol. 2009;15:2834–8.PubMedPubMedCentralCrossRefGoogle Scholar
  13. Davis PJ, Davis FB. Hyperthyroidism in patients over the age of 60 years: clinical features in 85 patients. Medicine. 1974;53:161–6.PubMedCrossRefGoogle Scholar
  14. Dickman R, Kislov J, Boaz M, Ron Y, et al. Prevalence of symptoms suggestive of gastroparesis in a cohort of patients with diabetes mellitus. J Diabetes Complicat. 2013;27(4):376–9.PubMedCrossRefGoogle Scholar
  15. Dixon JL, et al. Association between diabetes and esophageal cancer, independent of obesity, in the United States veterans affairs population. Dis Esophagus. 2016;29(7):747–751.PubMedCrossRefGoogle Scholar
  16. Ebert EC. The thyroid and the gut. J Clin Gastroenterol. 2010;44:402–6.PubMedGoogle Scholar
  17. Ehehalt F, et al. Neuroendocrine tumors of the pancreas. Oncologist. 2009;14:456.PubMedCrossRefGoogle Scholar
  18. Elfström P, et al. Risk of thyroid disease in individuals with celiac disease. J Clin Endocrinol Metab. 2007;92:3915–9.CrossRefGoogle Scholar
  19. Ellis C, Nicoloff DM. Hyperparathyroidism and peptic ulcer disease. Arch Surg. 1968;96:114–8.PubMedCrossRefGoogle Scholar
  20. Felderbauer, et al. Mutations in the calcium-sensing receptor: a new genetic risk factor for chronic pancreatitis? Scand J Gastroenterol. 2006;41:343–8.PubMedCrossRefGoogle Scholar
  21. Fraenkel M, Kim M, Faggiano A, de Herder WW, Valk GD. Knowledge NETwork. Endocr Relat Cancer. 2014 May 6;21(3):R153–63.PubMedCrossRefGoogle Scholar
  22. Gardner EC, Hersch T. Primary hyperparathyroidism and the gastrointestinal tract. South Med J. 1981;74:197–9.PubMedCrossRefGoogle Scholar
  23. Gibbons D, Camilleri M, Nelson AD, Eckert D. Characteristics of chronic megacolon among patients diagnosed with multiple endocrine neoplasia type 2B. United European Gastroenterol J. 2016;4(3):449–54.PubMedCrossRefGoogle Scholar
  24. Goyal I, Panta R, Chaudhuri A. A rare case of pituitary mediated hypercortisolism (Cushing’s disease) with MEN-1 syndrome. Endocr Pract, suppl. Supplement 3; Jacksonville. 2017;23:188.Google Scholar
  25. Harrison B, et al. The Association of Primary Hyperparathyroidism with Pancreatitis. J Clin Gastroenterol. 2012;46:656–61.Google Scholar
  26. Hosono K, Endo H, Takahashi H, et al. Metformin suppresses colorectal aberrant crypt foci in a short-term clinical trial. Cancer Prev Res. 2010;3(9):1077–83.CrossRefGoogle Scholar
  27. Jacob JJ, et al. Does hyperparathyroidism cause pancreatitis? ANZ J Surg. 2006;76:740–4.PubMedCrossRefGoogle Scholar
  28. Jodkowska A, et al. Interdisciplinary aspects of primary hyperparathyroidism: symptomatology in a series of 100 cases. Adv Clin Exp Med. 2016;25:285–93.PubMedCrossRefGoogle Scholar
  29. Jorde R, Saleh F, Sundfjord J, Haug E, et al. Coeliac disease in subjects with secondary hyperparathyroidism. Scand J Gastroenterol 2005;40:178–92.PubMedCrossRefGoogle Scholar
  30. Karaus M, Wienback M, Grussendorf M, Erckenbrecht JF, et al. Intestinal motor activity in experimental hyperthyroidism in conscious dogs. Gastroenterology 1989;97:911–19.PubMedCrossRefGoogle Scholar
  31. Khater D. Endocrinopathies in celiac disease: when the endocrinologist sees what is invisible to the gastroenterologist. Acta Biomed. 2018;9:117–21.Google Scholar
  32. Khoo TK, et al. Acute pancreatitis in primary hyperparathyroidism: a population-based study. J Clin Endocrinol Metab. 2009;94:2115–28.PubMedPubMedCentralCrossRefGoogle Scholar
  33. Kim D, Ryan J. Gastrointestinal manifestations of systemic diseases. In: Feldman et al, editor. Gastrointestinal and liver disease: pathophysiology/diagnosis/management. 7th ed. 2002. Philadelphia: SaundersGoogle Scholar
  34. Lauritano EC, et al. Association between hypothyroidism and small intestinal bacterial overgrowth. J Clin Endocrinol Metab. 2008;92:4180–5.CrossRefGoogle Scholar
  35. Lin TY, et al. Incidence of abnormal liver biochemical tests in hyperthyroidism. Clin Endocrinol. 2017;86:755–9.CrossRefGoogle Scholar
  36. Mantovani A, et al. Association between primary hypothyroidism and NAFLD: a systematic review and meta-analysis. Thyroid. 2018;28:1270–6.PubMedCrossRefGoogle Scholar
  37. Maser C, et al. Gastrointestinal manifestations of endocrine disease. World J Gastroenterol. 2006;12:3174–9.PubMedPubMedCentralCrossRefGoogle Scholar
  38. Matsumoto AM, Robertson RP. Commentary: geriatric endocrinology: an important competency for endocrinologists in an aging society. Endocrine News. 2016;1–4.Google Scholar
  39. Norton JA, et al. Prospective study of surgery for primary hyperparathyroidism (HPT) in multiple endocrine neoplasia-type 1 and Zollinger-Ellison syndrome: long-term outcome of a more virulent form of HPT. Ann Surg. 2008;247:501–10.PubMedPubMedCentralCrossRefGoogle Scholar
  40. Noto H, et al. Hyperthyroidism presenting as dysphagia. Intern Med. 2000;39:472–3.PubMedCrossRefGoogle Scholar
  41. Rao RH, Vagnucci AH, Amico JA. Bilateral Massive Adrenal Hemorrhage: Early Recognition and Treatment. Ann Intern Med. 1989;110:227–235.PubMedCrossRefGoogle Scholar
  42. Shah VN, et al. Effect of gender, biochemical parameters & parathyroid surgery on gastrointestinal manifestations of symptomatic primary hyperparathyroidism. Indian J Med Res. 2014;139:279–84.PubMedPubMedCentralGoogle Scholar
  43. Sharma, et al. Colorectal manifestations of endocrine disease. Dis Colon Rectum. 1995;38:318–23.PubMedCrossRefGoogle Scholar
  44. Stepanchick A, et al. Calcium sensing receptor mutations implicated in pancreatitis and idiopathic epilepsy syndrome disrupt an arginine-rich retention motif. Cell Physiol Biochem. 2010;26:363–74.PubMedPubMedCentralCrossRefGoogle Scholar
  45. Tun-Abraham ME, et al. Acute pancreatitis associated with hypercalcemia. Cir Cir. 2015;83:227–31.PubMedGoogle Scholar
  46. Valera M, et al. Primary biliary cirrhosis: a thirteen year experience. Rev Clin Med. 2006;134:469–74.Google Scholar
  47. Wang X, et al. The effect of periodontal treatment on hemoglobin a1c levels of diabetic patients: a systematic review and meta-analysis. PLoS One. 2014;9:1084.Google Scholar
  48. Wegener M, et al. Effect of hyperthyroidism on the transit of a caloric solid-liquid meal through the stomach, the small intestine, and the Colon in man. J Clin Endocrinol Metab. 1992;75:745–9.PubMedGoogle Scholar
  49. Zawada, et al. Gastrointestinal complications in patients with diabetes mellitus. Adv Clin Exp Med. 2018;27:567–72.PubMedCrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Kiran Patel College of Osteopathic MedicineNova Southeastern UniversityFort LauderdaleUSA

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