Rama Walia1, Amandeep Singh2, Anshita Aggarwal3, Baburam Thapa4, Manni Luthra Guptasarma5, Anil Bhansali3, Niranjan Khandelwal6. 1. Department of Endocrinology, Postgraduate Institute of Medical Education & Research, Chandigarh, 160012, India. ramawalia@rediffmail.com. 2. Department of Internal Medicine, Postgraduate Institute of Medical Education & Research, Chandigarh, India. 3. Department of Endocrinology, Postgraduate Institute of Medical Education & Research, Chandigarh, 160012, India. 4. Department of Gastroenterology, Postgraduate Institute of Medical Education & Research, Chandigarh, India. 5. Department of Immunopathology, Postgraduate Institute of Medical Education & Research, Chandigarh, India. 6. Department of Radiodiagnosis, Postgraduate Institute of Medical Education & Research, Chandigarh, India.
Abstract
OBJECTIVE: Short stature (SS) is a common manifestation of celiac disease (CD). After starting gluten free diet (GFD), children usually have catch-up growth (improvement in height SDS of >1 SD). However, few children in remission, even on GFD, lack catch up growth. This study was planned to assess the growth hormone (GH) axis and the prevalence of anti-pituitary antibodies in such patients. METHODS: It was a single-centre, prospective study. Patients with CD in remission for the last 1 y, having SS and lacking catch-up growth, were included after excluding other common causes of SS. GH dynamics were studied using stimulation tests: Insulin tolerance test, clonidine stimulation test, and glucagon stimulation test. GH deficiency (GHD) was defined as non-stimulable response to 2 GH stimulation tests. Anti-pituitary antibodies were analysed in these patients using rat pituitary extract as antigen. RESULTS: Ten patients (8 girls), with a mean age of 10 ± 2.8 y, in serological remission for CD and lacking catch-up growth, were enrolled. All had a height SDS of < -2. Fifteen age matched children with CD and adequate catch up growth served as controls. GHD was seen in 7 patients (70%), out of whom 2 received GH therapy and had an improvement in the height SDS from -2.7 to -1.4 and from -2.1 to 2.4 (over 1 y), respectively. Anti-pituitary antibodies were seen in significant titres in 55.5% of the cases and 40% of the controls. CONCLUSIONS: Children with CD in remission but lacking catch-up growth should be evaluated for GHD.
OBJECTIVE: Short stature (SS) is a common manifestation of celiac disease (CD). After starting gluten free diet (GFD), children usually have catch-up growth (improvement in height SDS of >1 SD). However, few children in remission, even on GFD, lack catch up growth. This study was planned to assess the growth hormone (GH) axis and the prevalence of anti-pituitary antibodies in such patients. METHODS: It was a single-centre, prospective study. Patients with CD in remission for the last 1 y, having SS and lacking catch-up growth, were included after excluding other common causes of SS. GH dynamics were studied using stimulation tests: Insulin tolerance test, clonidine stimulation test, and glucagon stimulation test. GH deficiency (GHD) was defined as non-stimulable response to 2 GH stimulation tests. Anti-pituitary antibodies were analysed in these patients using rat pituitary extract as antigen. RESULTS: Ten patients (8 girls), with a mean age of 10 ± 2.8 y, in serological remission for CD and lacking catch-up growth, were enrolled. All had a height SDS of < -2. Fifteen age matched children with CD and adequate catch up growth served as controls. GHD was seen in 7 patients (70%), out of whom 2 received GH therapy and had an improvement in the height SDS from -2.7 to -1.4 and from -2.1 to 2.4 (over 1 y), respectively. Anti-pituitary antibodies were seen in significant titres in 55.5% of the cases and 40% of the controls. CONCLUSIONS:Children with CD in remission but lacking catch-up growth should be evaluated for GHD.
Entities:
Keywords:
Anti-pituitary antibody; Celiac disease; Growth hormone deficiency; Short stature