Celiac disease, short stature and growth hormone deficiency

Celiac disease (CD) is the most common genetically-based diseased associated with food intolerance. In children, the classical form of CD, presenting with gastrointestinal symptoms, starts before 2 years of age, after the introduction of gluten in the diet. Oligosymptomatic CD and atypical presentations are common, including short stature as the only clinical manifestation. Impaired growth in children with CD results mainly from nutritional deficits, and withdrawal of gluten from the diet is associated with a marked improvement of linear growth. Rarely, when catch-up growth does not occur after the initiation of a glutenfree diet (GFD), growth hormone (GH) deficiency must be investigated. One of the possible causes for the GH deficiency is an autoimmune form of hypophysitis. In view of the inflammatory and nutritional aspects of CD, with elevated cytokines and low body weight, some aspects of the physiological system that regulate body weight, fat stores, energy intake and energy expenditure should be discussed. Leptin, the anorexigenic peptide hormone produced by the ob gene and secreted mainly by adipocytes, belongs to the long-chain helical cytokine family and is involved in immune regulation. Leptin secretion is reduced during periods of fasting and leptin levels are low in children with CD. Ghrelin, the orexigenic hormone isolated from stomach that stimulates GH secretion, induces a positive energy balance and can override the anorectic action of leptin. Ghrelin levels are increased in children with CD. In this review, we will focus some aspects of the complex network involving nutrition, GH secretion and the energy metabolism regulation in children with CD.