Endocrinological Disorders and Celiac Disease

Abstract

Celiac disease is a permanent intolerance to dietary gluten. Its well known features are abdominal symptoms, malabsorption of nutrients, and small-bowel mucosal inflammation with villous atrophy, which recover on a gluten-free diet. Diagnosis is challenging in that patients often suffer from subtle, if any, symptoms. The risk of clinically silent celiac disease is increased in various autoimmune conditions. The endocrinologist, especially, should maintain high suspicion and alertness to celiac disease, which is to be found in 2-5% of patients with insulin-dependent diabetes mellitus or autoimmune thyroid disease. Patients with multiple endocrine disorders, Addison's disease, alopecia, or hypophysitis may also have concomitant celiac disease. Similar heredity and proneness to autoimmune conditions are considered to be explanations for these associations. A gluten-free diet is essential to prevent celiac complications such as anemia, osteoporosis, and infertility. The diet may also be beneficial in the treatment of the underlying endocrinological disease; prolonged gluten exposure may even contribute to the development of autoimmune diseases. The diagnosis of celiac disease requires endoscopic biopsy, but serological screening with antiendomysial and antitissue transglutaminase antibody assays is an easy method for preliminary case finding. Celiac disease will be increasingly detected provided the close association with autoimmune endocrinological diseases is recognized.

Celiac disease in children and adolescents at a singe center in Saudi Arabia

“…A significant proportion of children with CD can be detected by screening children with genetic risk, such as children with type 1 DM. Type 1 DM has been associated with diabetes mellitus,14 and a higher percentage was reported from our region 1516. It was considered the most common indication for regular screening for CD.…”

Celiac Disease and Autoimmunity in the Gut and Elsewhere

“…Serological screening for CD in AIDDM populations showed a median prevalence of 4.1% among 40 studies; these included primarily European centers as well as 6 centers from the USA and UK. [33] Gastrointestinal symptoms attributed to celiac disease among AIDDM patients are generally mild. Active malabsorption may lead to unreliable carbohydrate absorption and hence unpredictable glucose responses to meals.…”

“…CD diagnosis often follows within one year of the AIDDM diagnosis. [33] It is has not been universally accepted that all AIDDM patients should be screened for celiac disease, though some advocate screening for CD at intervals in children with AIDDM due primarily to the prevalence and the potential consequences of delayed diagnosis. [34] While it is rational to expect that early treatment would prevent complications of CD in this population there is little actual data that documents such benefit.…”

“…[35] Occurrence of hyperthyroidism in adult celiac disease patients ranges from 0.1 to 5.2% (average 2.3%), while occurrence of hypothyroidism ranged from 0 to 5.8% (average 2.6%). [33] Whilst there is not sufficient data available to advocate screening for CD in patients with thyroid disease a much greater awareness should lead to a low threshold for testing. An awareness of the converse relationship is also crucial, as thyroid disease may explain fatigue and additional constitutional symptoms in treated CD.…”

Screening of celiac disease in patients with autoimmune thyroid disease from Southern Brazil

“…The prevalence of CD in the Brazilian general population, specifically of Curitiba (Southern region), an area with predominantly European ancestry, is 1:417 (11). In patients with inadequate control of ATD, using high doses of levothyroxine, CD must be evaluated (12). CD can manifest with typical symptoms, such as growth failure, loss of weight, diarrhea, and deficiency of various nutrients, and with atypical symptoms, such as osteoporosis and infertility.…”