Mechanisms of Abnormal Puberty in Coeliac Disease

Abstract

Coeliac disease (CD) is one of the most frequent chronic diseases in childhood. The clinical spectrum has changed; in addition to the classical gastrointestinal form, other clinical manifestations have been described, such as hypogonadism and the consequent delay in onset of puberty. Recent studies reported not only a significantly retarded menarche in untreated CD girls as compared with girls following a gluten-free diet, but also in treated CD a negative effect on pregnancy, resulting in lower birth weight and shorter duration of pregnancy. In boys, there is a reduced serum level of dihydrotestosterone and an increased serum level of luteinizing hormone, an abnormality pattern suggesting androgen resistance. The pathogenesis of CD-related reproductive disorders is still unclear. Some hypotheses may be tried; for example, in CD there is a high level of autoantibodies directed against self-antigens, so there could be antibodies directed against hormones or organs critical for pubertal development. Moreover, in CD there could be a selective malabsorption of micronutrients essential for the metabolism of carrier or receptor proteins for sex hormones.

Gynecologic and Obstetric Findings Related to Nutritional Status and Adherence to a Gluten-Free Diet in Brazilian Patients with Celiac Disease

“…Adult celiac group: 76 patients, mean age 38.8 years (19-74 years) (see Table 1), divided into 4 subgroups according to the degree of malnutrition (Tables 1, 2 Table 6); Group 4. Child/Adolescent Celiac Group: 18 patients diagnosed as having CD in early infancy, childhood or adolescence, divided into 2 subgroups according to adherence to a GFD (see Table 6): Celiacs adherent to a GFD: 8 patients, mean actual age 15.5 years (12)(13)(14)(15)(16)(17)(18); Celiacs not adherent to a GFD: 10 patients, mean actual age 19.9 years (11-37) (see Table 6). …”

Extraintestinal manifestations of coeliac disease

“…102 Delayed puberty In addition to the classic gastrointestinal form, children with coeliac disease can also present with a delayed onset of puberty due to hypogonadism. 104 Delayed menarche has been documented in girls with coeliac disease, but not in those on a gluten-free diet. 104 Androgen resistance, evidenced by reduced serum levels of dihydrotestosterone and increased serum levels of luteinizing hormone has been implicated in the development of coeliac disease in boys.…”

“…104 Delayed menarche has been documented in girls with coeliac disease, but not in those on a gluten-free diet. 104 Androgen resistance, evidenced by reduced serum levels of dihydrotestosterone and increased serum levels of luteinizing hormone has been implicated in the development of coeliac disease in boys. 104 The mechanism underpinning delayed puberty associated with coeliac disease has not been definitely established.…”

“…104 Androgen resistance, evidenced by reduced serum levels of dihydrotestosterone and increased serum levels of luteinizing hormone has been implicated in the development of coeliac disease in boys. 104 The mechanism underpinning delayed puberty associated with coeliac disease has not been definitely established. Potential explanations include the possibility that autoimmune factors, directed against hormones, receptors or endocrine organs, and the effect of the overall increased inflammatory milieu can delay puberty.…”

Enfermedad celíaca. Una mirada actual

“…Numerosos estudios documentan el impacto de la mala absorción de nutrientes tanto en niños como en adultos, incluso cuando no es evidente un síndrome de malabsorción 36 . Un estudio realizado por Bona mostró que la baja ingesta alimentaria o la mala absorción de vitaminas del complejo B, hierro y ácido fólico parecen parcialmente responsables del retraso de la pubertad en niños con EC 37 . En adultos, también se ha descrito correlación entre la deficiencia de zinc y severidad del aplanamiento de las vellosidades, junto con lesiones histológicas más severas en sujetos cuyos niveles de hierro, cobre, ácido fólico y vitamina B-12 eran menores 38 .…”