Autoimmune Adrenal Insufficiency in Celiac Disease

Hugh J Freeman^1,

¹Department of Medicine (Gastroenterology), UBC Hospital, Vancouver, BC, Canada

Cite this paper:
Hugh J Freeman. Autoimmune Adrenal Insufficiency in Celiac Disease. International Journal of Celiac Disease. 2016; 4(3):84-86. doi: 10.12691/ijcd-4-3-5

Abstract

Celiac disease is an immune-mediated intestinal disorder that may be associated with other immune-mediated extra-intestinal disorders, including immune-mediated endocrine diseases, such as autoimmune thyroiditis, most often with hypothyroidism. Other monoglandular autoimmune endocrine disorders may also occur, including autoimmune adrenal insufficiency (Addison’s disease). In celiac disease, clinical features of adrenal failure may be limited, difficult to differentiate from symptoms that might be attributed to celiac disease, or even life-threatening. In others with celiac disease, a polyglandular autoimmune syndrome has also been reported. Recent screening studies from multiple countries, particularly in , have indicated that patients with autoimmune adrenal failure or Addison’s disease should be carefully screened for occult or silent celiac disease. Up to 10% of Addisonian patients may be serologically positive and histopathological features of untreated celiac disease may be detected, even with clinically occult intestinal disease. Celiac disease patients with a monoglandular autoimmune disorder should also be followed carefully for the later appearance of other autoimmune endocrine disorders as these may not all appear at the time of diagnosis of celiac disease, but sporadically during the life-long clinical course of celiac disease.

Keywords:
Addison’s Disease Autoimmune Adrenal Insufficiency Celiac Disease Hypothyroidism Polyglandular Endocrine Failure

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References:

[1]	Freeman HJ. Celiac Disease. Reference Module in Biomedical Sciences. 2014 Elsevier. 15-Oct-14.
[2]	Freeman HJ. Celiac-associated autoimmune thyroid disease: a study of 16 patients with overt hypothyroidism. Can J Gastroenterol 1995; 9: 242-246.
[3]	Freeman HJ, Maguire J. Sellar inflammatory mass in inflammatory bowel disease. Can J Gastroenterol 2010; 24: 58-60.
[4]	Liddle GW, Melmon KL. The Adrenals. Chapter 5. In: Textbook of Endocrinology 5th Edition, Ed. Williams RH, W B Saunders Company, Philadelphia, London, Toronto, 1974; 233-322.
[5]	Valentino R, Savastano S, Tommaselli AP, Dorato M, Scarpitta MT, Gigante M, Lombardi G, Troncone R. Unusual association of thyroiditis, Addison’s disease, ovarian failure and celiac disease in a young woman. J Endocrinol Invest 1999; 22: 390-394.
[6]	Heneghan MA, McHugh P, Stevens FM, McCarthy CF. Addison’s disease and selective IgA deficiency in two celiac patients. Scand J Gastroenterol 1997; 32: 509-511.
[7]	Stenhammar LC, Hogberg LM, Nordwall M, Stromberg LG. Moderate dose inhaled budesonide disguising symptoms of Addison’s disease in an asthmatic boy with silent celiac disease. J Pediatr Pharmacol Ther 2005; 10: 100-103.
[8]	O’Leary C, Walsh CH, Wieneke P, O’Regan P, Buckley B, O’Halloran DJ, Ferriss JB, Quigley EM, Annis P, Shanahan F, Cronin CC. Celiac disease and autoimmune Addison’s disease: a clinical pitfall. QJM 2002; 95: 79-82.
[9]	Myhre AG, Aarsetoy H, Undlien ED, Hovdenak N, Aksnes L, Husebye ES. High frequency of celiac disease among patients with autoimmune adrenocortical failure. Scand J Gastroenterol 2003; 38: 511-515.
[10]	Kaukinen K, Collin P, Mykkanen AH, Partanen J, Maki M, Salmi J. Celiac disease and autoimmune endocrinologic disorders. Dig Dis Sci 1999; 44: 1428-1433.
[11]	Biagi F, Campanella J, Soriani A, Vailati A, Corazza GR. Prevalence of celiac disease in Italian patients affected by Addison’s disease. Scand J Gastroenterol 2006; 4: 302-305.
[12]	Elfstrom P, Montgomery SM, Kampe O, Ekbom A, Ludvigsson JF. Risk of primary adrenal insufficiency in patients with celiac disease. J Clin Endocrinol Metab 2007; 92: 3595-3598.
[13]	Betterle C, Lazzarotto F, Spadaccino AC, Basso D, Plebani M, Pedini B, Chiarelli S, Albergoni M. Celiac disease in North Italian patients with autoimmune Addison’s disease. Eur J Endocrino 2006; 154: 275-279.
[14]	Betterle C, Volpato M, Pedini B, Chen S, Rees-Smith B, Furmaniak J. Adrenal cortex autoantibodies (ACA) and steroid-producing cells autoantibodies (StCA) in patients with Addison’s disease: comparison between immunofluorescence and immunoprecipitation assays. J Clin Endo Metab 1999; 84: 618-622.
[15]	Fichna M, Fichna P, Gryczynska M, Walkowiak J, Zurawek M, Sowinski J. Screening for associated autoimmune disorders in Polish patients with Addison’s disease. Endocrine 2010; 37: 349-360.
[16]	Van den Driessche A, Eenkhooorn V, Van Gaal L, De Block C. Type 1 diabetes and autoimmune polyglandular syndrome: a clinical review. J Medicine 2009; 67: 376-387.
[17]	Lakhotia M, Pahadia HR, Kumar H, Singh J, Tak S. A case of autoimmune polyglandular syndrome (APS) type II with hypothyroidism, hypoadrenalism, and celiac disease---a rare combination. J Clin Diagn Res 2015; 9: OD01-3.
[18]	Matsueda K, Rosenberg IH. Malabsorption with idiopathic hypoparathyroidism responding to treatment with coincident celiac sprue. Dig Dis Sci 1982; 27: 269-273.
[19]	Hrubiskova K, Jackuliak P, Vanuga P, Pura M, Payer J. Autoimmune polyendocrine syndrome type 2 associated with autoimmune hypophysitis and celiac disease. Vnitr Lek 2010; 56: 1169-1176.
[20]	Ramadhan A, Tamilia M. Treatment-refractory hypothyroidism. CMAJ 2012; 184: 205-209.