Endocrine Abstracts

Endocrine management of the patient with coeliac disease (CD) can be divided between management of the long-term consequences of malabsorption and timely identification and treatment of associated autoimmune disorders. CD patients have chronic calcium and vitamin D malabsorption at diagnosis, leading to secondary hyperparathyroidism, which is frequently associated with hypocalcaemia, low BMD and osteopenia. In many cases these will improve following institution of a gluten-free diet alone. It is important to distinguish osteoporosis from osteomalacia and serum 25-hydroxyvitamin D levels should be measured and replaced aggressively. Despite malabsorption, it is rarely necessary to give parenteral vitamin D, and moderate oral doses of colecalciferol (i.e. 2000 IU daily) are generally sufficient for maintenance. If hypocalcaemia is persistent in the face of adequate serum 25-hydroxyvitamin D levels, oral calcium should be replaced. It is reasonable to monitor BMD every 2 to 5 years during follow up. Hypothyroidism is the most frequent autoimmune condition associated with CD. Higher doses of levothyroxine are often needed in CD and fluctuating serum TSH levels may reflect variable dietary compliance. When combined with type 1 diabetes or Addison’s disease, CD can also lead to problems in glycaemic control or cortisol replacement.

Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.