Endocrine Abstracts

Introduction: Celiac disease (CD) an autoimmune disorder of the small intestine, was considered as a disease of childhood. The symptoms can be obvious. That is the main reason why CD is underdiagnosed in elderly patients.

Aims & Methods: The purpose of our study was to demonstrate a clinical case of CD which was diagnosed in a 41-year-old female patient. The patient attended our clinic with complains of weakness, tenderness, abdominal distension, weight loss. Laboratory tests find severe iron deficiency anemia (HB -9 g/dl, Ery- 3.1×10¹²/l, serum iron 4 mmol/l) and severe hypocoagolopathy (prothrombine index- 48%, INR-2.98, but mild thrombocytopenia 130×10/l). She had suffered with these symptoms for 2 years.

Results: Number of investigations was performed. We also checked parathormone which revealed secondary hyperparathyroidism (parathhormon 187 pg/ml, Ca- 1.01 mmol/l). The hemolytic anemia was excluded (haptoglobin was in normal range). Stool examination revealed no pathogens.

It was believed that she has these symptoms due to her anemia. After 2 weeks occurred the oedema of abdomen and diarrhea of 3–4 watery stools daily and night tremor and seizure due to hypoglycaemia (2.3 mmol/l). Ultrasound investigation of abdomen showed very rush peristalsis of small and large intestines, but no ascites, significant meteorism.

CD was suspected. Serologic test for anti-gliadin antibodies was positive. Another examination of the biopsy after the first endoscopy revealed extensive collagen depositions in the lamina propria of the small bowel, giving the diagnosis of CD. Also antibodies against Transglutaminase were positive. After gluten-free diet the above mentioned symptoms disappeared and patient’s anemia and blood clot markers as well as parathormone and Ca level were well controlled.

Conclusion: The presence of other immune-related diseases in our case suggests that immunological mechanism plays a crucial role in CD. We recommend active specific screening in older patients belonging to at risk-group like other autoimmune disorders. Disappeared and patient’s anemia and blood clot markers as well as parathormone level were well controlled.