Horm Metab Res 2023; 55(11): 781-787
DOI: 10.1055/a-2156-2773
Original Article: Endocrine Care

Serological Screening for Celiac Disease and Gastrointestinal Absorption Disorders in Patients with Autoimmune Endocrine Diseases

1   Endocrinology, Bursa City Hospital, Bursa, Turkey
,
Soner Cander
2   Endocrinology, Uludag University Faculty of Medicine, Bursa, Turkey
,
Özen Öz Gül
2   Endocrinology, Uludag University Faculty of Medicine, Bursa, Turkey
,
Pınar Sisman
3   Endocrinology, Medicana Health Group, Bursa, Turkey
,
Canan Ersoy
2   Endocrinology, Uludag University Faculty of Medicine, Bursa, Turkey
,
Erdınc Erturk
2   Endocrinology, Uludag University Faculty of Medicine, Bursa, Turkey
› Author Affiliations

Abstract

Celiac disease (CD) accompanying autoimmune endocrine diseases (AED) is generally asymptomatic. This study aimed to evaluate the frequency of clinically overt or silent CD in patients diagnosed with autoimmune endocrinopathy and the clinical effects of silent CD in these endocrinopathies. The study included 166 patients with known or newly diagnosed mono-/polyglandular AED and 90 age- and gender-matched healthy controls. The patients were classified into four groups: type 1 diabetes mellitus (DM) (n=44), Hashimoto’s thyroiditis (HT) (n=68), Addison’s disease (AD) (n=17), and autoimmune polyglandular syndrome (APS) (n=37). All subjects were serologically screened for tissue transglutaminase antibody (tTG) IgA and IgG. In addition, to evaluate the possible systemic consequences of CD, serum parathormone (PTH), 25-hydroxicholecalsiferol (25-OH-Vit D), vitamin B12, folic acid, iron, iron-binding capacity (IBC), and ferritin levels were measured. In the total series, 193 (75.4%) individuals were females, and 63 (24.6%) were males. TTG IgA antibody positivity was found in 23 among 166 patients, while no positivity was encountered in the healthy control group. The highest rates of positive tTg IgA frequency were detected in AD, with 29.4% (5/17). Serum 25-OH-Vit D, vitamin B12, folic acid, iron, and ferritin levels were significantly lower in AEDs compared to controls (p<0.001), and the lowest these parameters were detected in patients with AD. The serologic CD prevalence is higher in autoimmune mono-/and polyglandular endocrine diseases than in the control group. The data support recommends regular screening for CD in all patients with AEDs.



Publication History

Received: 06 May 2023

Accepted after revision: 17 August 2023

Accepted Manuscript online:
17 August 2023

Article published online:
05 October 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Sahin Y. Celiac disease in children: a review of the literature. World J Clin Pediatr 2021; 10: 53-71
  • 2 Raiteri A, Granito A, Giamperoli A. et al. Current guidelines for the management of celiac disease: a systematic review with comparative analysis. World J Gastroenterol 2022; 28: 154-175
  • 3 Kahaly GJ, Frommer L, Schuppan D. Celiac disease and glandular autoimmunity. Nutrients 2018; 10: 814
  • 4 Collin P, Reunala T, Pukkala E. et al. Coeliac disease-associated disorders and survival. Gut 1994; 35: 1215-1218
  • 5 Cronin CC, Shanahan F. Insulin-dependent diabetes mellitus and coeliac disease. Lancet 1997; 349: 1096-1097
  • 6 Volta U, De Franceschi L, Molinaro N. et al. Frequency and significance of anti-gliadin and anti-endomysial antibodies in autoimmune hepatitis. Dig Dis Sci 1998; 43: 2190-2195
  • 7 Fasano A. Clinical presentation of celiac disease in the pediatric Population. Gastroenterology 2005; 128: 68-73
  • 8 Pham-Short A, Donaghue KC, Ambler G. et al. Screening for celiac disease in type 1 diabetes: a systematic review. Pediatrics 2015; 136: 170-176
  • 9 Kahaly GJ, Frommer L. Polyglandular autoimmune syndromes. J Endocrinol Invest 2018; 41: 91-98
  • 10 Förster G, Krummenauer F, Kühn I. et al. Das polyglanduläre Autoimmunsyndrom Typ II: Epidemiologie und Manifestationsformen [Polyglandular autoimmune syndrome type II: epidemiology and forms of manifestation]. Dtsch Med Wochenschr 1999; 124: 1476-1481
  • 11 Betterle C, Furmaniak J, Sabbadin C. et al. Type 3 autoimmune polyglandular syndrome (APS-3) or type 3 multiple autoimmune syndrome (MAS-3): an expanding galaxy. J Endocrinol Invest 2023; 46: 643-665
  • 12 Cutolo M. Autoimmune polyendocrine syndromes. Autoimmun Rev 2014; 13: 85-89
  • 13 Rodrigo L. Celiac disease. World J Gastroenterol 2006; 12: 6585-6593
  • 14 Aygun C, Uraz S, Damci T. et al. Celiac disease in an adult Turkish population with type 1 diabetes mellitus. Dig Dis Sci 2005; 50: 1462-1466
  • 15 Valentino R, Savastano S, Tommaselli AP. et al. Prevalence of coeliac disease in patients with thyroid autoimmunity. Horm Res 1999; 51: 124-127
  • 16 Berti I, Trevisiol C, Tommasini A. et al. Usefulness of screening program for celiac disease in autoimmune thyroiditis. Dig Dis Sci 2000; 45: 403-406
  • 17 Volta U, Ravaglia G, Granito A. et al. Coeliac disease in patients with autoimmune thyroiditis. Digestion 2001; 64: 61-65
  • 18 Garnier-Lengline H, Cerf-Bensussan N, Ruemmele FM. Celiac disease in children. Clin Res Hepatol Gastroenterol 2015; 39: 544-551
  • 19 Raiteri A, Granito A, Giamperoli A. et al. Current guidelines for the management of celiac disease: a systematic review with comparative analysis. World J Gastroenterol 2022; 28: 154-175
  • 20 Bai JC, Ciacci C. World gastroenterology organisation global guidelines: celiac disease February 2017. J Clin Gastroenterol 2017; 51: 755-768
  • 21 Elsurer R, Tatar G, Simsek H. et al. Celiac disease in the Turkish population. Dig Dis Sci 2005; 50: 136-142
  • 22 Dahele A, Kingstone K, Bode J. et al. Anti-endomysial antibody negative celiac disease: does additional serological testing help?. Dig Dis Sci 2001; 46: 214-221
  • 23 Cataldo F, Marino V, Ventura A. et al. Prevalence and clinical features of selective immunoglobulin A deficiency in coeliac disease: an Italian multicentre study. Italian Society of Paediatric Gastroenterology and Hepatology (SIGEP) and "Club del Tenue" Working Groups on Coeliac Disease. Gut 1998; 42: 362-365
  • 24 Betterle C, Lazzarotto F, Spadaccino AC. et al. Celiac disease in North Italian patients with autoimmune Addison’s disease. Eur J Endocrinol 2006; 154: 275-279
  • 25 Robles DT, Fain PR, Gottlieb PA. et al. The genetics of autoimmune polyendocrine syndrome type II. Endocrinol Metab Clin North Am 2002; 31: 353-368
  • 26 Ansaldi N, Palmas T, Corrias A. et al. Autoimmune thyroid disease and celiac disease in children. J Pediatr Gastroenterol Nutr 2003; 37: 63-66
  • 27 Sahin Y, Evliyaoglu O, Erkan T. et al. The frequency of celiac disease in children with autoimmune thyroiditis. Acta Gastroenterol Belg 2018; 81: 5-8
  • 28 Collin P, Kaukinen K, Välimäki M. et al. Endocrinological disorders and celiac disease. Endocr Rev 2002; 23: 464-483
  • 29 Sahin Y, Cakir MD, Isakoca M. et al. Prevalence of celiac disease in children with type 1 diabetes mellitus in the South of Turkey. Iran J Ped 2020; 30: e97306
  • 30 Husby S, Koletzko S, Korponay-Szabó IR. et al. ESPGHAN working group on coeliac disease diagnosis; ESPGHAN gastroenterology committee; European Society for Pediatric Gastroenterology, Hepatology, and Nutrition. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr 2012; 54: 136-160
  • 31 Spadaccino AC, Basso D, Chiarelli S. et al. Celiac disease in North Italian patients with autoimmune thyroid diseases. Autoimmunity. 2008; 41: 116-121
  • 32 O'Leary C, Walsh CH, Wieneke P. et al. Coeliac disease and autoimmune Addison’s disease: a clinical pitfall. QJM. 2002; 95: 79-82
  • 33 Kumar R, Reddy DV, Unnikrishnan AG. et al. Polyglandular autoimmune endocrinopathy in type 2 diabetes. J Assoc Physicians India 2004; 52: 999-1000
  • 34 Chiang JL, Maahs DM, Garvey KC. et al. Type 1 diabetes in children and adolescents: a position statement by the American Diabetes Association. Diabetes Care 2018; 41: 2026-2044
  • 35 Warriner AH, Saag KG. Glucocorticoid-related bone changes from endogenous or exogenous glucocorticoids. Curr Opin Endocrinol Diabetes Obes 2013; 20: 510-516