title: Low testosterone in non-responsive coeliac disease: A case series, case-control study with comparisons to the National Health and Nutrition Examination Survey.
abstract: BACKGROUND
  Adults with coeliac disease (CD) often report persistent fatigue, even when CD appears well controlled for unknown reasons.
  
  
  OBJECTIVE
  To evaluate common indications for testosterone panel (TP) testing and prevalence of low testosterone (T) in CD.
  
  
  METHODS
  In our case series, we determined common indications for checking TP in CD. Next, we conducted a case-control study to compare TP in CD vs. healthy controls (HC). We compared mean total T (TT), free T (FT) based on serologic, histologic disease activity. Finally, we assessed TT in tissue transglutaminase (tTG)+ vs. tTG- subjects and CD vs. HC obtained from the National Health and Nutrition Examination Survey (NHANES).
  
  
  RESULTS
  53 coeliac males had TP tested. Common indications included osteoporosis and fatigue. Low FT was observed in 7/13 men with osteoporosis and 5/6 with fatigue. In our case-control study (n=26 each), there was no difference in mean TT or FT between CD vs. HC, tTG+ vs tTG- or Marsh 0 vs. Marsh 3 groups. NHANES data showed no difference in mean TT between tTG+ vs tTG- (n=16 each) or CD vs. HC subjects (n=5 each).
  
  
  CONCLUSIONS
  Low T occurs in CD patients at a similar rate as the general population. Common presentations of low T may mimic non-responsive CD symptoms.
authors.affiliation: Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Coeliac Research Program, Harvard Medical School, Boston, MA, USA. Electronic address: skurada@bidmc.harvard.edu.
authors.forename: Satya
authors.initials: S
authors.lastname: Kurada
authors.affiliation: Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Coeliac Research Program, Harvard Medical School, Boston, MA, USA.
authors.forename: Gopal
authors.initials: G
authors.lastname: Veeraraghavan
authors.affiliation: Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Coeliac Research Program, Harvard Medical School, Boston, MA, USA.
authors.forename: Dharmesh
authors.initials: D
authors.lastname: Kaswala
authors.affiliation: Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Coeliac Research Program, Harvard Medical School, Boston, MA, USA.
authors.forename: Josh
authors.initials: J
authors.lastname: Hansen
authors.affiliation: Division of Endocrinology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: David
authors.initials: D
authors.lastname: Cohen
authors.affiliation: Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Coeliac Research Program, Harvard Medical School, Boston, MA, USA.
authors.forename: Ciaran
authors.initials: C
authors.lastname: Kelly
authors.affiliation: Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, MA, USA; Coeliac Research Program, Harvard Medical School, Boston, MA, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Leffler
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002446:Celiac Disease / Q000150:complications* / Q000453:epidemiology*; D016208:Databases, Factual; D005221:Fatigue / Q000209:etiology; D019204:GTP-Binding Proteins / Q000097:blood; D006801:Humans; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D010024:Osteoporosis / Q000453:epidemiology*; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D012189:Retrospective Studies; D013739:Testosterone / Q000097:blood*; D011503:Transglutaminases / Q000097:blood
chemical_list: D013739:Testosterone; D000091345:Protein Glutamine gamma Glutamyltransferase 2; D011503:Transglutaminases; D019204:GTP-Binding Proteins
keywords: Coeliac disease; Fatigue; Non responsive coeliac disease; Osteoporosis; Testosterone