Short stature in children with coeliac disease

Coeliac disease (CD) is a genetically determined gluten-sensitive enteropathy resulting in nutrient malabsorption, with an increasing incidence world-wide. Clinical presentation in early childhood may include classic malabsorption symptoms, whereas older CD children often present extra-intestinal symptoms including short stature and pubertal delay. A gluten-free diet (GFD) generally leads to a rapid catch-up in growth and to normalization of the pituitary function. The pathogenesis of CD-associated short stature is still unclear. Besides the involvement of the growth hormone (GH)/insulin-like growth factor-I axis, a role for ghrelin was recently proposed. Furthermore, some CD patients do not show catch-up growth during GFD, despite reversion to seronegativity for CD markers including antiendomysial and anti-tissue transglutaminase antibodies. These subjects show GH deficiency and could potentially benefit from recombinant human GH therapy. This review deals with the management of short stature and the evaluation of growth axis function in CD children.