Endocrine Abstracts

Introduction: Celiac disease (CD) is an autoimmune enteropathy, induced by dietary gluten in genetically predisposed subjects, which manifests itself, most often, by digestive signs but also extra-digestive signs, in particular failure to thrive (FTT), nevertheless it is necessary to remain vigilant with regard to a real associated somatotropic deficit.

CASE: A 14-years-old male patient, followed for a celiac disease since the age of 6 years, under a strict gluten-free diet, referred to our consultation for a severe failure to thrive. A workup was performed in favor of low IGF1 level with complete insufficient Growth hormone (GH) response to insulin hypoglycemia test. In addition, the hypothalamic- pituitary MRI was in favor of pituitary hypotrophy. Growth hormone replacement therapy was initiated with good clinical outcome.

Discussion & Conclusion: The coexistence of CD and Growth Hormone deficiency (GHD) is rare and estimated at 0.02 to 0.26%. The GHD could be a result of CD or an association of the two conditions. The mechanism of the impairment of hypothalamic control of GH secretion is not very clear. Malnutrition could have a direct effect on the circulating gluten peptides in the brain, affecting the hypothalamic and pituitary control. Also, it has been suggested that a systemic autoimmune inflammatory reaction involving TNF-alpha could have a negative interference in growth. In the other hand, the presence of antibodies against the hypothalamus and the pituitary gland may be suggested as an autoimmune origin of this association especially in the presence of morphological findings on hypothalamic-pituitary MRI.