Introduction: Autoimmune polyglandular syndromes are characterized by the coexistence of at least two autoimmune endocrinopathies. Organ-specific autoimmunity is frequent in patients with type 1 diabetes mellitus (T1DM). The aim of this study was to estimate the prevalence of celiac disease and other autoimmune diseases like thyroiditis, pernicious anemia and adrenal failure among adult patients with T1DM.
Methods/design: Sixty-nine, asymptomatic patients with T1DM (32 females, 37 males), aged between 16 and 51 years were screened for celiac disease using antigliadin Ig A-G (AGA), endomisyal antibodies (EMA), anti-tissue transglutaminase (tTG). Endoscopic biopsies were performed for patients with positive antibody results. HLA-DQA1, HLA-DQB1 and HLA-DRB1 were available for 37 patients. Thyroid function tests, antithyroglobulin, antiperoxidase antibodies, level of vitamin B12, basal cortisol were measured for each patient.
Results: AGA was positive for 15 patients, EMA for two patients and tTG was positive for three patients; EMA and tTG positive patients were also positive for AGA. Endoscopic biopsies were performed in 10 patients, five patient did not accept to go undergo endoscopy. Two cases (2.9%) took a diagnosis of celiac disease with positive endoscopic biopsies revealing total mucosal atrophy. Increased intraepithelial lymphocyte count was present in four patients and gastritis was detected for remaining three patients. All patients were screened for autoimmune thyroid disease, adrenal disease and deficiency of vitamin B12. There were four (5.8%) cases of subclinical hypothyroid and three (4,3%) cases of overt hypothyroid patients. All were antibody positive. Thyroid antibodies were detected in 16 (23%) patients with normal thyroid function. Insulin tolerance test was performed for two patients whom basal cortisol levels were low. One took a diagnosis of Addison (1.4%). There were seven (10.1%) patients with vitamin B12 deficiency. Of 37 patients, HLA-DQA1 was positive for 25 patients, HLA-DQB1 for 24 patients and HLA-DRB1 for 18 patients. Although six patients were negative for HLA, one had high levels of thyroid antibodies and one had deficiency of vitamin B12.
Conclusion: Clinicians should be aware of possible autoimmune disease among patients with T1DM.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.
05 - 09 May 2012
European Society of Endocrinology