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.
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
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
Bancos I, Hahner S, Tomlinson J, et al. The Lancet Diabetes and Endocrinology. 2015;3(3):216–226.Google Scholar
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
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
Chiu, et al. Dysphagia as a manifestation of thyrotoxicosis: report of three cases and literature review. Dysphagia. 2004;19:120–4.PubMedGoogle Scholar
Ciobanu L, Dumitrascu DL. Gastrointestinal motility disorders in endocrine diseases. Pol Arch Med Wewn. 2011;121:129–36.PubMedGoogle Scholar
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
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
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
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
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
Harrison B, et al. The Association of Primary Hyperparathyroidism with Pancreatitis. J Clin Gastroenterol. 2012;46:656–61.Google Scholar
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
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
Lauritano EC, et al. Association between hypothyroidism and small intestinal bacterial overgrowth. J Clin Endocrinol Metab. 2008;92:4180–5.CrossRefGoogle Scholar
Lin TY, et al. Incidence of abnormal liver biochemical tests in hyperthyroidism. Clin Endocrinol. 2017;86:755–9.CrossRefGoogle Scholar
Mantovani A, et al. Association between primary hypothyroidism and NAFLD: a systematic review and meta-analysis. Thyroid. 2018;28:1270–6.PubMedCrossRefGoogle Scholar
Matsumoto AM, Robertson RP. Commentary: geriatric endocrinology: an important competency for endocrinologists in an aging society. Endocrine News. 2016;1–4.Google Scholar
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
Rao RH, Vagnucci AH, Amico JA. Bilateral Massive Adrenal Hemorrhage: Early Recognition and Treatment. Ann Intern Med. 1989;110:227–235.PubMedCrossRefGoogle Scholar
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
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
Tun-Abraham ME, et al. Acute pancreatitis associated with hypercalcemia. Cir Cir. 2015;83:227–31.PubMedGoogle Scholar
Valera M, et al. Primary biliary cirrhosis: a thirteen year experience. Rev Clin Med. 2006;134:469–74.Google Scholar
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
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
Zawada, et al. Gastrointestinal complications in patients with diabetes mellitus. Adv Clin Exp Med. 2018;27:567–72.PubMedCrossRefGoogle Scholar