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World J Gastroenterol. Oct 14, 2016; 22(38): 8472-8479
Published online Oct 14, 2016. doi: 10.3748/wjg.v22.i38.8472
Endocrine manifestations in celiac disease
Hugh James Freeman
Hugh James Freeman, Department of Medicine (Gastroenterology), University of British Columbia, Vancouver, BC V6T 1W5, Canada
Author contributions: Freeman HJ is responsible for all of this manuscript.
Conflict-of-interest statement: There is no conflict of interest for the author in this manuscript.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hugh James Freeman, MD, CM, FRCPC, FACP, Department of Medicine (Gastroenterology), University of British Columbia, 2211 Wesbrook Mall, Vancouver, BC V6T 1W5, Canada. hugfree@shaw.ca
Telephone: +1-604-8227216 Fax: +1-604-8227236
Received: June 29, 2016
Peer-review started: June 30, 2016
First decision: July 29, 2016
Revised: August 5, 2016
Accepted: August 23, 2016
Article in press: August 23, 2016
Published online: October 14, 2016
Abstract

Celiac disease (CD) is an autoimmune small intestinal mucosal disorder that often presents with diarrhea, malabsorption and weight loss. Often, one or more associated endocrine disorders may be associated with CD. For this review, methods involved an extensive review of published English-language materials. In children and adolescents, prospective studies have demonstrated a significant relationship to insulin-dependent or type 1 diabetes, whereas in adults, autoimmune forms of thyroid disease, particularly hypothyroidism, may commonly co-exist. In some with CD, multiple glandular endocrinopathies may also occur and complicate the initial presentation of the intestinal disease. In others presenting with an apparent isolated endocrine disorder, serological screening for underlying subclinical CD may prove to be positive, particularly if type 1 diabetes, autoimmune thyroid or other autoimmune endocrine diseases, such as Addison’s disease are first detected. A number of reports have also recorded hypoparathyroidism or hypopituitarism or ovarian failure in CD and these may be improved with a strict gluten-free diet.

Keywords: Pituitary insufficiency, Ovarian infertility, Celiac disease, Gluten-sensitive enteropathy, Endocrine disorders, Thyroiditis, Hypothyroidism, Diabetes, Adrenal insufficiency

Core tip: Celiac disease (CD) is an immune-mediated intestinal disorder that may be closely linked to a number of extra-intestinal disorders, particularly endocrine diseases. These include thyroiditis, particularly in adults, and insulin-dependent diabetes mellitus, particularly in children and adolescents. Other endocrine disorders have also been recorded, including adrenal insufficiency and pituitary disease. Usually, only a single endocrine gland is involved in CD, but changes in multiple different glands has also been recorded. If an endocrine disorder is present, screening for CD, even without gastrointestinal symptoms, has been recommended. In established CD, regular follow-up and evaluation for the possible appearance of an occult endocrine disorder may also be appropriate.