ESPE Abstracts

Background: Coeliac disease(CD)is a common cause of stunted growth. Despite adherence to gluten-free diet(GFD), short stature may persist in some patients with CD. Studies investigating the growth hormone(GH)-insulin like growth factor-1(IGF1) axis in children and adolescents withCDare scant and inconclusive. Fibroblast growth factor-21(FGF-21)is a181amino acid polypeptide that plays a role in growth, lipid and glucose metabolism. The inhibitory effects of FGF21 on GH action are direct, and may result from the reduced translocation of GH receptors from the cytoplasm to the cell membrane. Elevated serum FGF21levels are associated with short stature in children with malnutrition. Data regarding serumFGF21levels in patients with CD are currently unavailable.

Aims: To assess the current stature of patients withCDadherent toGFD, to determine the frequency of growth hormone(GH)deficiency and to investigate the associations of serum IGF1, IGF binding protein-3(IGFBP3) and FGF21 levels with stature in patients withCD.

Patients and Methods: 141(79 females) consecutive patients withCD who were adherent to GFDfor at least two years were enrolled in the study. Demographic, clinical and biochemical data were retrieved from structured, electronic medical files. Standard methods were used for current anthropometric measurements and pubertal staging. Fasting blood samples for serumIGF1, IGFBP3 and FGF21 levels were drawn. Patients with height standard deviation(SD)1.5 SD below target height (TH)underwent GH stimulation tests (clonidine and L-dopa). Comparisons of clinical and laboratory data of patients with height SD within range of TH and those below TH were performed. Significance was granted for p < 0.05.

Results: The median age of the patients was11.3yr(range:3.0-18.0yr). Median duration of follow-up was4.6 yr(range:2.0-14.3 yr). Sixteen(11.3%) patients had short stature, i.e. height SD< -2 and 21(14.9 %) patients had body mass index SD<-2. Forty-eight(34.0%) patients were prepubertal. Of the 12(8.5%) patients with height SD<1.5 SD of TH,3(2.1%) patients had GHD. Serum IGF1 SDand IGFBP3 SD were significantly higher in patients with height SD within TH than those with height SD below TH and without GHD(P=0.009and0.002; respectively). Serum FGF21 levels in patients with height SD within TH and those with height SD belowTH were not different(P=0.765). Serum FGF21levels were not significantly correlated with any of the clinical and laboratory variables investigated in the study (P>0.05for all).

Conclusions: The frequency of GHD in our cohort was 2.1%. The lower IGF1 and IGFBP3 levels in non-GHD patients below TH may suggest GH resistance. Serum FGF21 levels were not associated with stunted growth in our cohort.