Growth hormone deficiency and coeliac disease: an unusual association?
OBJECTIVE
To assess the occurrence of growth hormone deficiency (GHD) in patients with coeliac disease (CD).


METHODS
A total of 1066 children diagnosed elsewhere with short stature were referred to our centre for second-line evaluation in a 6-year period. All patients were screened for CD by antiendomysial antibodies (EMA) and those with positive sera underwent intestinal biopsy.


RESULTS
Among the 1066 short children, 210 (19.7%) had GHD and 12 (1.12%; chronological age from 3.6 to 12.3 years, bone age from 1.5 to 10.5 years, SDS height from -3.05 to -0.48), having positive EMA, showed histologically confirmed CD. Nine of these latter 12 CD children had a beneficial effect on growth rate after the first year of gluten-free diet, while the remaining three showed no catch-up growth. A careful endocrinological investigation in these three CD boys showed an isolated GHD in two cases and a multiple GHD in one case. The congenital origin of GHD is supported by the congenital abnormalities documented by magnetic resonance imaging. GH therapy associated with gluten-free diet led to an increased growth rate.


CONCLUSIONS
GH secretion should be evaluated in coeliac patients showing no catch-up growth after a period on a gluten-free diet in spite of reversion to seronegativity for EMA. In the case of GHD and CD, replacement GH therapy should be started during a gluten-free diet.
Bozzola
Mauro
M
Pediatric Department, University of Pavia, Pavia, Italy. m.bozzola@smatteo.pv.iy
Giovenale
Diletta
D
Bozzola
Elena
E
Meazza
Cristina
C
Martinetti
Miryam
M
Tinelli
Carmine
C
Corazza
Gino Roberto
GR
D000293:Adolescent; D002446:Celiac Disease / Q000150:complications* / Q000178:diet therapy / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D005260:Female; D005983:Glutens / Q000008:administration & dosage; D006130:Growth Disorders / Q000150:complications* / Q000188:drug therapy / Q000235:genetics; D006683:HLA-DQ Antigens / Q000235:genetics; D059848:HLA-DQ alpha-Chains; D059866:HLA-DQ beta-Chains; D006650:Histocompatibility Testing; D019382:Human Growth Hormone / Q000172:deficiency* / Q000627:therapeutic use; D006801:Humans; D008297:Male
D006683:HLA-DQ Antigens; D059848:HLA-DQ alpha-Chains; D059866:HLA-DQ beta-Chains; C069050:HLA-DQA1 antigen; C069051:HLA-DQB1 antigen; D019382:Human Growth Hormone; D005983:Glutens