Endocrine Abstracts

JOINT3548

Introduction: Celiac disease (CD) is an autoimmune disorder in which gluten ingestion triggers an immune response, leading to small intestinal damage and impaired nutrient absorption. This can result in various symptoms such as diarrhea, weight loss, fatigue, and bloating, though some patients may be asymptomatic. CD is also associated with extra-intestinal complications, including endocrine manifestations. In some cases, short stature may be the only clinical sign of CD. The primary treatment is a strict, lifelong gluten-free diet (GFD). We present a case of a female patient with CD and idiopathic Growth Hormone (GH) Deficiency (GHD), underlying the need for continuous monitoring of growth response post-GFD.

Methods: A 10-year, 6-month-old prepubertal girl (Tanner stage I) was evaluated for short stature. Her growth rate was 2.5 cm/year, and her height and weight were below the 3rd percentile. Her medical history was unremarkable, except for chronic constipation since infancy, managed with macrogol. Laboratory tests revealed IGF-1: 71 ng/ml, tTG-IgA: 116.4 U/ml, and IgA: 144 mg/dL. A gastroenterological evaluation, including biopsy, confirmed mild chronic enteritis consistent with a malabsorption syndrome. She was started on a GFD and monitored every six months.

Results: After two years on a GFD, her tTG-IgA levels normalized, but her growth rate did not improve as expected. Further endocrinological assessment confirmed GHD. The patient started GH therapy, and over the next four years, she gained 25.5 cm in height.

Conclusion: GH secretion should be evaluated in children with CD who fail to achieve expected growth recovery despite adherence to a GFD and normalized tTG-IgA levels. The exact pathophysiological link between CD and idiopathic GHD remains unclear, but their coexistence suggests a potential association. This case highlights the importance of a multidisciplinary approach in the early diagnosis and management of growth disorders in children with CD. Pediatric endocrinologists and general pediatricians should be monitoring growth response post-GFD initiation to ensure timely intervention if GHD is present.