Pekka Collin,
Katri Kaukinen,
Matti Välimäki and
Jorma Salmi
Department of Medicine, Tampere University Hospital and University of Tampere, 33014 Tampere, Finland; and Division of Endocrinology, Department of Medicine, Helsinki University Central Hospital, 00290 Helsinki, Finland
Correspondence: Address all correspondence and requests for reprints to: Pekka Collin, Medical School, University of Tampere, 33014 Tampere, Finland. E-mail: pekka.collin{at}uta.fi
Celiac disease is a permanent intolerance to dietary gluten.Its well known features are abdominal symptoms, malabsorptionof nutrients, and small-bowel mucosal inflammation with villousatrophy, which recover on a gluten-free diet. Diagnosis is challengingin that patients often suffer from subtle, if any, symptoms.The risk of clinically silent celiac disease is increased invarious autoimmune conditions. The endocrinologist, especially,should maintain high suspicion and alertness to celiac disease,which is to be found in 2–5% of patients with insulin-dependentdiabetes mellitus or autoimmune thyroid disease. Patients withmultiple endocrine disorders, Addison’s disease, alopecia,or hypophysitis may also have concomitant celiac disease. Similarheredity and proneness to autoimmune conditions are consideredto be explanations for these associations. A gluten-free dietis essential to prevent celiac complications such as anemia,osteoporosis, and infertility. The diet may also be beneficialin the treatment of the underlying endocrinological disease;prolonged gluten exposure may even contribute to the developmentof autoimmune diseases. The diagnosis of celiac disease requiresendoscopic biopsy, but serological screening with antiendomysialand antitissue transglutaminase antibody assays is an easy methodfor preliminary case finding. Celiac disease will be increasinglydetected provided the close association with autoimmune endocrinologicaldiseases is recognized.
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