Short Stature as the Major Manifestation of Celiac Disease in Older Children

Abstract

Celiac disease was diagnosed by jejunal biopsy and response to gluten elimination in 11 of 23 children with short stature referred after negative endocrine evaluation. The mean age of the group was 11 years, with a range of 5-16. All had been followed for a mean of 2.5 years at a large pediatric endocrine clinic for the evaluation of growth retardation. Bone age retardation of more than 25 percent of the chronologic age was found in all children. Microcytic anemia and past history of gastrointestinal problems were typical of the celiac group but were not documented in the nonceliac patients. Stool fat excretion was a specific but insensitive test, while the 1-hour blood xylose test was of no value in differentiating between the two groups. Close cooperation between pediatric endocrinology and gastroenterology clinics may be fruitful in the identification of celiac patients, especially in a group of older children with short stature, bone age retardation, and microcytic anemia.

Screening children with severe short stature for celiac disease using tissue transglutaminase

“…The prevalence of CD was higher (35-59%) in the studies 11,[14][15][16][17][18] where either the endocrinal workup had been done and/or the sample was very small. In rest of the studies 10,13,[19][20][21][22][23][24] where the endocrinal causes had not been ruled out in the selected children and/or the sample size was relatively larger, the prevalence reported was lower (1.7-8.3%).…”

Growth hormone impaired secretion and antipituitary antibodies in patients with coeliac disease and poor catch-up growth after a long gluten-free diet period: a causal association?

“…Coeliac disease (CD) is a permanent, genetically determined intolerance to gluten that results in entheropathy and frequent malabsorption in children that may impair final statural growth [4,7,8,27,31,32,43,46]. In fact, after starting a gluten-free diet (GFD), a significant increase in height and weight velocity has been evidenced [5,7,11,13,21,22,30], with weight reaching full catch-up growth in the first year of GFD and height reaching the expected centile after about 2 years [1,42,45].…”

Growth in Malnutrition Related to Gastrointestinal Diseases: Coeliac Disease

“…However, more recent reports have demonstrated the existence of certain forms of coeliac disease where the alteration in growth is the most evident clinical manifes tation [2][3][4][5]. At times, these cases are accompanied by hacmatological alterations and mild digestive problems.…”

“…However, their results have been discordant; some authors have reported modifications in the secre tion of growth hormone (GH) in response to diverse stim uli [8][9][10], while others have not been able to confirm these results [3,5]. In addition, some studies have re ported that the levels of insulin-like growth factor I (IGF-I) are reduced in this disease state and can be returned to normal with the exclusion of gluten from the diet [II,12].…”