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      Endocrinopathies in celiac disease: when the endocrinologist sees what is invisible to the gastroenterologist

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          Abstract

          Celiac disease (CD) is a systemic, immune mediated and genetically determined small intestinal disorder characterized by intolerance to dietary gluten that generally presents with gastrointestinal symptoms in young children and extra-intestinal manifestations. Furthermore, there is close association between CD and endocrine diseases, including diabetes, autoimmune thyroid diseases, growth and pubertal disorders, etc. probably due to the presence of a common genetic predisposition. The present review aims to highlight and give more insight to the endocrine changes in CD, especially when there are few or no gastrointestinal symptoms and to emphasize on screening opportunities in some endocrine diseases. (www.actabiomedica.it)

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          Shared and distinct genetic variants in type 1 diabetes and celiac disease.

          Deborah J Smyth, Vincent Plagnol, Neil M Walker … (2009)
          Two inflammatory disorders, type 1 diabetes and celiac disease, cosegregate in populations, suggesting a common genetic origin. Since both diseases are associated with the HLA class II genes on chromosome 6p21, we tested whether non-HLA loci are shared. We evaluated the association between type 1 diabetes and eight loci related to the risk of celiac disease by genotyping and statistical analyses of DNA samples from 8064 patients with type 1 diabetes, 9339 control subjects, and 2828 families providing 3064 parent-child trios (consisting of an affected child and both biologic parents). We also investigated 18 loci associated with type 1 diabetes in 2560 patients with celiac disease and 9339 control subjects. Three celiac disease loci--RGS1 on chromosome 1q31, IL18RAP on chromosome 2q12, and TAGAP on chromosome 6q25--were associated with type 1 diabetes (P<1.00x10(-4)). The 32-bp insertion-deletion variant on chromosome 3p21 was newly identified as a type 1 diabetes locus (P=1.81x10(-8)) and was also associated with celiac disease, along with PTPN2 on chromosome 18p11 and CTLA4 on chromosome 2q33, bringing the total number of loci with evidence of a shared association to seven, including SH2B3 on chromosome 12q24. The effects of the IL18RAP and TAGAP alleles confer protection in type 1 diabetes and susceptibility in celiac disease. Loci with distinct effects in the two diseases included INS on chromosome 11p15, IL2RA on chromosome 10p15, and PTPN22 on chromosome 1p13 in type 1 diabetes and IL12A on 3q25 and LPP on 3q28 in celiac disease. A genetic susceptibility to both type 1 diabetes and celiac disease shares common alleles. These data suggest that common biologic mechanisms, such as autoimmunity-related tissue damage and intolerance to dietary antigens, may be etiologic features of both diseases. 2008 Massachusetts Medical Society
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            Systematic review with meta-analysis: associations between coeliac disease and type 1 diabetes.

            P Elfström, J Sundström, J F Ludvigsson (2014)
            In the past decade, a number of population-based studies have examined the prevalence of coeliac disease in individuals with type 1 diabetes but prevalences have differed considerably.
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              Celiac disease and autoimmune thyroid disease.

              Chin Lye Ch'ng, Jeremy Kingham, Hannah M Jones (2007)
              Celiac disease (CD) or gluten sensitive enteropathy is relatively common in western populations with prevalence around 1%. With the recent availability of sensitive and specific serological testing, many patients who are either asymptomatic or have subtle symptoms can be shown to have CD. Patients with CD have modest increases in risks of malignancy and mortality compared to controls. The mortality among CD patients who comply poorly with a gluten-free diet is greater than in compliant patients. The pattern of presentation of CD has altered over the past three decades. Many cases are now detected in adulthood during investigation of problems as diverse as anemia, osteoporosis, autoimmune disorders, unexplained neurological syndromes, infertility and chronic hypertransaminasemia of uncertain cause. Among autoimmune disorders, increased prevalence of CD has been found in patients with autoimmune thyroid disease, type 1 diabetes mellitus, autoimmune liver diseases and inflammatory bowel disease. Prevalence of CD was noted to be 1% to 19% in patients with type 1 diabetes mellitus, 2% to 5% in autoimmune thyroid disorders and 3% to 7% in primary biliary cirrhosis in prospective studies. Conversely, there is also an increased prevalence of immune based disorders among patients with CD. The pathogenesis of co-existent autoimmune thyroid disease and CD is not known, but these conditions share similar HLA haplotypes and are associated with the gene encoding cytotoxic T-lymphocyte-associated antigen-4. Screening high risk patients for CD, such as those with autoimmune diseases, is a reasonable strategy given the increased prevalence. Treatment of CD with a gluten-free diet should reduce the recognized complications of this disease and provide benefits in both general health and perhaps life expectancy. It also improves glycemic control in patients with type 1 diabetes mellitus and enhances the absorption of medications for associated hypothyroidism and osteoporosis. It probably does not change the natural history of associated autoimmune disorders.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Acta Biomed
                Journal ID (iso-abbrev): Acta Biomed
                Title: Acta bio-medica : Atenei Parmensis
                Publisher: Mattioli 1885 (Italy )
                ISSN (Print): 0392-4203
                Publication date (Print): 2018
                Volume: 89
                Issue: 1
                Pages: 117-121
                Affiliations
                [1]Department of Pediatrics, Endocrinology Unit, Alexandria University Children’s Hospital, Egypt, and Child Health Department, Sultan Qaboos University Hospital, Muscat, Oman
                Author notes
                Correspondence: Doaa Khater, MD Alexandria University Children’s Hospital Chatby, AlGaish Street Alexandria (Egypt) Tel. 0096898216884 Fax 002034824244 E-mail: duaayasseen@ 123456yahoo.com
                Article
                Publisher ID: ACTA-89-117
                DOI: 10.23750/abm.v89i1.7119
                PMC ID: 6357610
                PubMed ID: 29633735
                SO-VID: 5f02a932-340a-45b3-a433-e33e7c3affa9
                Copyright © Copyright: © 2018 ACTA BIO MEDICA SOCIETY OF MEDICINE AND NATURAL SCIENCES OF PARMA
                License:

                This work is licensed under a Creative Commons Attribution 4.0 International License

                History
                Date received : 12 January 2018
                Date accepted : 21 February 2018
                Categories
                Subject: Pediatric Endocrinology Update - Review

                Keywords: celiac disease,endocrine disorders,autoimmune thyroiditis,diabetes,adrenal insufficiency
                Data availability:
                Keywords: celiac disease, endocrine disorders, autoimmune thyroiditis, diabetes, adrenal insufficiency

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