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Growth failure from symptomless celiac disease. A study of 14 patients
Insights
Celiac disease (CD) can cause abnormally short stature in children, even without digestive symptoms. Early diagnosis via jejunal biopsy is crucial for growth failure evaluation.
Area of Science:
- Pediatric Endocrinology
- Gastroenterology
- Genetics
Background:
- Abnormally short stature is a common concern in pediatric endocrinology.
- Celiac disease (CD) is an autoimmune disorder typically associated with gastrointestinal symptoms.
- Undiagnosed CD can lead to various complications, including growth impairment.
Purpose of the Study:
- To investigate the role of celiac disease (CD) in pediatric patients presenting with abnormally short stature.
- To determine if CD can cause growth failure in the absence of overt gastrointestinal symptoms.
- To assess the utility of jejunal biopsy in the diagnostic workup for short stature.
Main Methods:
- Retrospective analysis of 14 children and adolescents with abnormally short stature.
- Evaluation of gastrointestinal symptoms, bone age, and growth patterns.
- Hormonal assessments including growth hormone (GH) and ACTH stimulation tests.
- Histopathological examination of jejunal biopsies for CD diagnosis.
Main Results:
- Celiac disease was identified as the cause of abnormally short stature in all 14 patients, despite the absence of current gastrointestinal symptoms.
- Growth failure was evident from early childhood, with a significant lag in bone age.
- Subnormal growth hormone (GH) responses were observed in 4 patients, and subnormal ACTH responses in 2.
- One patient exhibited permanent isolated GH deficiency secondary to CD.
Conclusions:
- Celiac disease should be considered in the differential diagnosis of abnormally short stature in children and adolescents, irrespective of gastrointestinal symptoms.
- Jejunal biopsy is a valuable diagnostic tool for identifying CD in cases of unexplained growth failure.
- Routine screening for CD via jejunal biopsy is recommended for abnormally short stature, particularly after the first year of life.
Abstract:
In 14 children and adolescents, abnormally short stature was shown to be due to celiac disease (CD) though the patients had no current gastrointestinal symptoms. Growth failure had appeared in the first years of life, and was associated with a marked lag in bone age. Subnormal growth hormone (GH) responses were demonstrated in 4 patients, and subnormal ACTH responses in 2. In 1 patient permanent isolated GH deficiency coincided with CD. A jejunal biopsy should form part of the routine diagnostic evaluation for abnormally short stature, except in patients who have had normal growth during the first year of life.