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.

Scopo : Valutare se il valore ADC può consentire una distinzione tra stenosi fibrotiche e infiammatorie nelle MICI pediatriche. Materiali e metodi: Da Febbraio 2010 a Novembre 2012, 14 pazienti di età compresa tra 7,2 e 16 anni (media 11,9) in follow up per morbo di Crohn stenosante accertato endoscopicamente, sono stati sottoposti ad esame RM DWI e calcolo dell’ADC. Sono stati esaminati 8 segmenti ileali e 6 colici. Durante la valutazione endoscopica sono stati effettuati prelievi bioptici: lo stadio di malattia è stato distinto in lieve, moderato e severo. Abbiamo confrontato i risultati dell’istologia con l’ ADC.Risultati: Il range dell’ADC calcolato in corrispondenza dei segmenti stenotici e substenotici è risultato compreso tra 400 e 1800 mm2/sec. In tutti i casi l’esame RM convenzionale ha confermato il reperto endoscopico di stenosi o substenosi. La misurazione dell’ADC ha dimostrato che ai valori più bassi (400/850 mm2/sec) corrispondevano istologicamente stenosi infiammatorie con edema marcato ed elevata cellularità, mentre ai valori più elevati (850/1800 mm2/sec) corrispondevano stenosi fibrotiche. Conclusioni: Nella nostra esperienza, seppur limitata dall’esiguità del campione, il valore di ADC misurato in corrispondenza dei segmenti stenotici può essere utile strumento nel differenziare le stenosi infiammatorie da quelle fibrotiche.

Abstract Background/Aims: Prolactin (PRL) is produced by the anterior pituitary gland. It exerts its role on the breast gland but also plays a modulatory role in autoimmune mechanisms. Celiac disease (CD) is a gluten-sensitive autoimmune enteropathy sometimes associated with autoimmune endocrinopathies. No data on PRL levels in CD patients are available at diagnosis, and no conclusive data are reported. Methods: We aimed to evaluate PRL secretion in newly diagnosed CD pediatric patients and, in the case of hyperprolactinemia, any changes in its levels while the patients were on a gluten-free diet (GFD). We recruited 67 patients and 39 healthy controls. Results: PRL was statistically higher in the CD patients (13.5 ± 9.2 ng/ml) than in the controls (8.5 ± 5.0 ng/ml). In the CD group, PRL was inversely correlated with the age at diagnosis (r = -0.326; p = 0.007). In patients with hyperprolactinemia at diagnosis, PRL decreased after 6 months of GFD. Conclusion: This paper confirms that PRL may be increased at diagnosis of CD and shows, for the first time, that it decreases after a short course of GFD. Changes in the levels of inflammatory cytokines in CD may account for changes in PRL levels. Younger patients seem more prone to develop hyperprolactinemia than older ones.