The coeliac disease is the autoimmunity disease of small intestine, which is the immune response result to various proteins of cereals, especially wheat gliadin. in adulthood it often manifests with various symptomatology, which includes metabolic osteopathy arising on secondary hyperparathyreosis.
There is casuistic model of 24-year-old patient with Down syndrome and documented autoimmunity thyroiditis, where the coeliac disease manifested by serious hypocalcemia with patologic fractures of both femur necks.
In our endocrinology ambulance, she was consulted because of the legs swelling with the suspicion for the insufficient thyroidal hormones substitution. She had bones pains for 1 year sharply worsening last month and finished to total immobility. During laboratory screening there was found serious hypocalcemia (Ca: 1.30 mmol/l, Ca2+: 0.94 mmol/l). Following examinations confirmed serious bones impact (T score 3.54, max in area of L4 5.155) and fractures of both femur necks.
Considering to known association between M. Down and coeliac disease there was added the antigliadin antibodies examination, antibodies against tissue transgutamilation and endomysial antibodies, which were highly positive and confirmed supposed malabsorption syndrome diagnosis.
At present day, the pacient adheres antigluten diet, serum concentrates of calcium are through permanent supplementation (Ca, vitamin D) near bottom limit of reference range and there is planned femur necks fractures solution.
There is frequent association between coeliac disease and other autoimmunity diseases particularly autoimmunity thyroiditis. The relationship between coeliac disease and autoimmunity thyroiditis was already described 30 years ago and on the base of present knowledges there is recomended according some authors to make screening for coeliac disease of the autoimmunity thyroiditis pacients and vice versa.
03 - 07 May 2008
European Society of Endocrinology