Evaluation of GH-IGF-I Axis in Adult Patients with Coeliac Disease

E. Ferrante; C. Giavoli; L. Elli; A. Redaelli; E. Novati; A. De Bellis; C. L. Ronchi; S. Bergamaschi; A. Lania; M. T. Bardella; G. Bellastella; P. Beck-Peccoz

doi:10.1055/s-0029-1241169

Hormone and Metabolic Research, Table of Contents

Horm Metab Res 2010; 42(1): 45-49
DOI: 10.1055/s-0029-1241169

Humans, Clinical

Evaluation of GH-IGF-I Axis in Adult Patients with Coeliac Disease

E. Ferrante¹ , C. Giavoli¹ , L. Elli² , A. Redaelli³ , E. Novati³ , A. De Bellis⁴ , C. L. Ronchi¹ , S. Bergamaschi¹ , A. Lania¹ , M. T. Bardella² , G. Bellastella⁴ , P. Beck-Peccoz¹

¹Endocrinology and Diabetology Unit, Department of Medical Sciences, University of Milan, Fondazione Ospedale Maggiore Policlinico IRCCS, Milan, Italy
²Center for the Prevention and Diagnosis of Coeliac Disease, Department of Medical Sciences, University of Milan, Fondazione Ospedale Maggiore Policlinico IRCCS, Milan, Italy
³Department of Internal Medicine, Digestive Endoscopy and Gastroenterology Unit, Ospedale San Gerardo, Monza, Italy
⁴Department of Clinical and Experimental Medicine and Surgery, Chair of Endocrinology, Second University of Naples, Naples, Italy

Abstract

The aim of this study was to evaluate GH/IGF-I axis and other pituitary functions in adult patients with coeliac disease. For this purpose, twenty-eight adult coeliac patients [20M, 8F:19–74 years; body mass index (BMI): 18.5–28 kg/m²] were recruited. Basal thyroid, adrenal and gonadal function, serum IGF-I and PRL, and routine parameters were evaluated. Dynamic GH secretion was carried out by GHRH plus arginine test. In 20 patients, antipituitary antibodies (APA) were also evaluated. Seven out of 28 patients, independently from disease onset and the gluten-free diet (GFD), showed an impaired GH secretion (25%). All were males, 2 with severe growth hormone deficiency (GHD) and 5 with partial GHD. In patients with GHD, as compared to coeliac patients with normal GH secretion, HOMA (2.1±1.2 vs. 0.9±0.4) and QUICKI (0.35±0.03 vs. 0.39±0.02) levels were significantly higher and lower, respectively, while IGF-I levels were slightly lower (17.7±3.7 vs. 24.7±6.3, p=NS). APA were negative in all 20 patients studied. In conclusion, a significant number of adult coeliac patients show an impaired GH secretion, this alteration being predominant in males and independent from disease onset and diet regimen. Given the absence of APAs, the cause of this pituitary dysfunction remains unclear even if a previous autoimmune involvement in some cases cannot be excluded.

Key words

GH deficiency - GH-IGF-I axis - coeliac disease

Full Text

References

1 Collin P, Kaukinen K, Välimäki M, Salmi J. Endocrinological disorders and coeliac disease. Endocr Rev. 2002; 23 464-483
2 Kumar V, Rajadhyaksha M, Wortsman J. Coeliac disease-associated autoimmune endocrinopathies. Clin Diagn Lab Immunol. 2001; 8 678-685
3 Collin P, Vilska S, Heinonen PK, Hällström O, Pikkarainen P. Infertility and coeliac disease. Gut. 1996; 39 382-384
4 Farthing MJ, Rees LH, Dawson AM. Male gonadal function in coeliac disease: III. Pituitary regulation. Clin Endocrinol (Oxf). 1983; 19 661-671
5 Farthing MJ, Rees LH, Edwards CR, Dawson AM. Male gonadal function in coeliac disease: 2. Sex hormones. Gut. 1983; 24 127-135
6 De Bellis A, Bizzarro A, Conte M, Perrino S, Coronella C, Solimeno S, Sinfisi AM, Stile LA, Pisano G, Bellastella A. Antipituitary antibodies in adults with apparently idiopathic growth hormone deficiency and in adults with autoimmune endocrine diseases. J Clin Endocrinol Metab. 2003; 88 650-654
7 De Bellis A, Bizzarro A, Perrino S, Coronella C, Conte M, Pasquali D, Sinfisi AA, Betterle C, Bellastella A. Characterization of antipituitary antibodies targeting pituitary hormone-secreting cells in idiopathic growth hormone deficiency and autoimmune endocrine diseases. Clin Endocrinol (Oxf). 2005; 63 45-49
8 De Bellis A, Salerno M, Conte M, Coronella C, Tirelli G, Battaglia M, Esposito V, Ruocco G, Bellastella G, Bizzarro A, Bellastella A. Antipituitary antibodies recognizing growth hormone (GH)-producing cells in children with idiopathic GH deficiency and in children with idiopathic short stature. J Clin Endocrinol Metab. 2006; 91 2484-2489
9 Bozzola M, Giovenale D, Bozzola E, Meazza C, Martinetti M, Tinelli C, Corazza GR. Growth hormone deficiency and coeliac disease: an unusual association?. Clin Endocrinol (Oxf). 2005; 62 372-375
10 Giovenale D, Meazza C, Cardinale GM, Sposito M, Mastrangelo C, Messini B, Citro G, Delvecchio M, Di Maio S, Bozzola M. The prevalence of growth hormone deficiency and coeliac disease in short children. Clin Med Res. 2006; 4 180-183
11 Giovenale D, Meazza C, Cardinale GM, Farinelli E, Mastrangelo C, Messini B, Citro G, Del Vecchio M, Di Maio S, Possenti I, Bozzola M. Growth hormone treatment in prepubertal children with coeliac disease and growth hormone deficiency. J Pediatr Gastroenterol Nutr. 2007; 45 4337
12 Iughetti L, De Bellis A, Predieri B, Bizzarro A, De Simone M, Balli F, Bellastella A, Bernasconi S. 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?. Eur J Pediatr. 2006; 165 897-903
13 Hutchinson JM, Robins G, Howdle PD. Advances in coeliac disease. Curr Opin Gastroenterol. 2008; 24 129-134
14 Ho KK. GH Deficiency Consensus Workshop Participants . Consensus guidelines for the diagnosis and treatment of adults with GH deficiency II: a statement of the GH Research Society in association with the European Society for Pediatric Endocrinology, Lawson Wilkins Society, European Society of Endocrinology, Japan Endocrine Society, and Endocrine Society of Australia. Eur J Endocrinol. 2007; 157 695-700
15 Corneli G, Di Somma C, Baldelli R, Rovere S, Gasco V, Croce CG, Grottoli S, Maccario M, Colao A, Lombardi G, Ghigo E, Camanni F, Aimaretti G. The cut-off limits of the GH response to GH-releasing hormone-arginine test related to body mass index. Eur J Endocrinol. 2005; 153 257-264
16 Ghigo E, Aimaretti G, Arvat E, Camanni F. Growth hormone-releasing hormone combined with arginine or growth hormone secretagogues for the diagnosis of growth hormone deficiency in adults. Endocrine. 2001; 15 29-38
17 Matthews DR, Hosker JP, Rudenski AS, Naylor BA, Treacher DF, Turner RC. Homeostasis model assessment: insulin resistance and β-cell function from fasting plasma glucose and insulin concentration in men. Diabetologia. 1985; 28 412-419
18 Katz A, Nambi SS, Mather K, Baron AD, Follmann DA, Sullivan G, Quon MJ. Quantitative insulin sensitivity check index: a simple, accurate method for assessing insulin sensitivity in humans. J Clin Endocrinol Metab. 2000; 85 2402-2410
19 Street ME, Volta C, Ziveri MA, Zanacca C, Banchini G, Viani I, Rossi M, Virdis R, Bernasconi S. Changes and relationships of IGFS and IGFBPS and cytokines in coeliac disease at diagnosis and on gluten-free diet. Clin Endocrinol (Oxf). 2008; 68 22-28
20 Colao A, Cerbone G, Pivonello R, Aimaretti G, Loche S, Di Somma C, Faggiano A, Corneli G, Ghigo E, Lombardi G. The growth hormone (GH) response to the arginine plus GH-releasing hormone test is correlated to the severity of lipid profile abnormalities in adult patients with GH deficiency. J Clin Endocrinol Metab. 1999; 84 1277-1282
21 Murray RD, Adams JE, Shalet SM. Adults with partial growth hormone deficiency have an adverse body composition. J Clin Endocrinol Metab. 2004; 89 1586-1591
22 Murray RD, Shalet SM. Insulin sensitivity is impaired in adults with varying degrees of GH deficiency. Clin Endocrinol (Oxf). 2005; 62 182-188

Correspondence

E. FerranteMD

Endocrinology and Diabetology Unit

Department of Medical Sciences Pad. Granelli

Via F. Sforza, 35

20122 Milan

Italy

Phone: +39/02/50 32 06 08

Fax: +39/02/50 32 06 05

Email: emanuele.ferrante@unimi.it