Pediatrics

Subject Category: Pediatrics

Am J Gastroenterol 2010; 105:691–696; doi:10.1038/ajg.2009.642; published online 10 November 2009

Anti-Pituitary Antibodies in Children With Newly Diagnosed Celiac Disease: A Novel Finding Contributing to Linear-Growth Impairment

Maurizio Delvecchio MD, PhD1, Annamaria De Bellis MD2, Ruggiero Francavilla MD3, Vincenzo Rutigliano MD3, Barbara Predieri MD4, Flavia Indrio MD3, Domenica De Venuto MD3, Antonio Agostino Sinisi MD2, Antonio Bizzarro MD2, Antonio Bellastella MD2, Lorenzo Iughetti MD4 and Luciano Cavallo MD3 on behalf of the Italian Autoimmune Hypophysitis Network Study

  1. 1Unità Operativa Complessa di Pediatria, IRCCS Casa Sollievo della Sofferenza, San Giovanni Rotondo (FG), Italy
  2. 2Department of Clinical and Experimental Medicine and Surgery F. Magrassi, A. Lanzara, Second University of Naples, Naples, Italy
  3. 3Department of Biomedicine of Developmental Age, University of Bari, Bari, Italy
  4. 4Department of Pediatrics, University of Modena and Reggio Emilia, Modena, Italy

Correspondence: Maurizio Delvecchio, MD, PhD, U.O.C. di Pediatria, IRCCS Casa Sollievo della Sofferenza—Viale Cappuccini, San Giovanni Rotondo (FG) 71013, Italy. E-mail: m.delvecchio@email.it

Received 15 December 2009; Accepted 25 June 2009; Published online 10 November 2009.

Top

Abstract

OBJECTIVES:

 

The possible autoimmune involvement of the pituitary gland in patients with celiac disease (CD) has been suggested but demonstrated in only a few patients on gluten-free diet. We aimed to assess the prevalence and clinical meaning of anti-pituitary antibodies (APA) in children and adolescents with the newly diagnosed CD.

METHODS:

 

A total of 119 patients with CD (0.9–15.8 years old) attending the inpatient clinic of University Hospital were recruited for the cross-sectional study. Their height, weight, and body mass index (BMI) were recorded, and insulin-like growth factor-1 (IGF-1) and APA were assayed. APA was also determined in 98 sex- and age-matched controls.

RESULTS:

 

APA were detected in 50 patients (42.0%), 15 of them with high titer (30%) and 35 with low titer (70%), and in 2 control subjects at low titer (2%) (P<0.001). IGF-1 was higher in patients with negative than with low titer (P=0.02) or high titer APA (P=0.03). Height was more reduced in high-titer APA patients than in the negative ones (P<0.01). Height was positively correlated with IGF-1 (P<0.01) and negatively with chronological age (P=0.001). IGF-1 was positively correlated with BMI (P<0.001). For height prediction the regression analysis showed the rank order 1 for chronological age and 2 for IGF-1.

CONCLUSIONS:

 

In this paper we have shown a remarkable prevalence of positive APA in newly diagnosed CD patients. High APA titers are associated with height impairment, likely mediated by a reduction of IGF-1, thus suggesting that autoimmune pituitary process could induce a linear-growth impairment.