Importance of gluten in the induction of endocrine autoantibodies and organ dysfunction in adolescent celiac patients

OBJECTIVE: It is well known that a high number of celiac patients may devel op autoantibodies against endocrine glands, but it has not yet been clarifi ed if this increased autoimmune response and the impaired organ function th at can develop may be related to the presence or absence of gluten in the d iet. The aim of the present study was to evaluate the effect of gluten on t he autoimmunity and function of the endocrine glands in adolescent celiac p atients. METHODS: To clarify this aspect we investigated 44 patients (28 females), a ged 11-20 yr (15.21 +/- 2.7 yr): 25 (mean age, 15.1 +/- 2.2 yr) on a gluten -free diet (treated patients) and 19 (mean age 15.4 +/- 2.9 yr) with a diet containing gluten (untreated patients). Forty adolescent subjects, aged 14 -19 yr (mean age, 14.9 +/- 2.7 yr), of whom 20 were females, were studied a s controls. Antibodies against the thyroid, adrenal, and pancreas were eval uated. Thyroid-stimulating hormone FT3, FT4, T3, T4, dehydroepiandrosterone sulphate, 17-OH progesterone, and cortisol, analyzed basally and 60 min af ter intravenous ACTH stimulation, were assayed to evaluate thyroid and adre nal function. The fasting glycemia level was used to evaluate the endocrine pancreas function. An ultrasonogram of the thyroid gland was performed on all patients. HLA class II typing for DR3 and DQB1 was performed in 32 of 4 4 patients. RESULTS: Seven of 44 (15.9%) patients were positive for antibodies against peroxidase. Six of 44 (13.6%) were positive for antibodies against thyreogl obulin and four of them also showed positive antibodies against peroxidase. Therefore, in nine of 44 at least one antibody directed against thyroid ti ssue was positive. Seven of 44 (15.9%) were positive for antibodies against islet cell, one of 44 (2.3%) positive for antibodies against glutamic acid decarboxilase, one of 44 (2.3%) positive for antibodies against insulin, a nd none for antibodies against islet cell- 512bdc. In 15 of 44 (34%) at lea st one antibody against an endocrine tissue was positive. The genotype DR3 was found in 21 of 32 (65.6%) celiac patients (10 in the untreated and II i n the treated group, respectively) and the genotype DQB 1*02 (DQ2) was foun d in 30 of 32 (93.8%) patients (16 in the treated and 14 in the untreated g roup, respectively). DHA-S values were significantly lower in the untreated (30.5 +/- 28.5 mu g/dl) than in the treated group (61.3 +/- 59.4 mu g/dl, p < 0.05), and both showing significantly (p < 0.01) lower levels with resp ect to the controls (161 +/- 52 mu g/dl). One patient showed diabetes, anot her one clinical hypothyroidism (thyroid-stimulating hormone > 6), and two patients showed preclinical hypothyroidism. Interestingly, at least one ant ibody was positive in 10 of 19 untreated patients (52.6%) but only in five of 25 treated patients (20%), with a significantly different distribution ( p < 0.001) between the two groups and without differences in the HLA genoty pe. The ultrasonographic evaluation of the thyroid resulted in a pathologic al score in six patients of the 44 examined (13.6%), suggesting the presenc e of thyropathy. CONCLUSIONS: The main results of this study are the high incidence of thyro id and pancreatic antibodies, and the possible role of gluten in the induct ion of the antibodies as well as, in few cases, the consequent organ dysfun ction. (C) 2000 by Am. Coll. of Gastroenterology).