Zusammenfassung
Autoimmun-Erkrankungen wie Zöliakie und Autoimmun-Thyreoiditis treten überproportional häufig bei Patienten mit Typ 1-Diabetes auf. Da diese Erkrankungen oft ohne eindeutige klinische Symptomatik verlaufen, kann ihre Früherkennung nur durch die serologische Bestimmung der spezifischen Autoantikörper erfolgen. In der Literatur wird die Prävalenz einer durch Screening-Verfahren entdeckten Zöliakie oder Autoimmun-Thyreoiditis bei jungen Patienten mit Typ 1-Diabetes im Mittel 10-mal höher angegeben als für die Normalbevölkerung. Bislang gibt es jedoch keine Einigkeit über ein einheitliches Vorgehen zum Screening und für die Indikation einer Behandlung bei klinisch nicht auffälligen Patienten mit serologisch nachweisbarer Autoimmunität. Zu spät erkannte Begleiterkrankungen können aber zu klinisch relevanten Stoffwechselproblemen und weiteren vermeidbaren Komplikationen führen.
Summary
Coeliac disease (CD) and autoimmune thyreoiditis (AIT) are associated with type-1 diabetes. These diseases frequently occur without apparent clinical symptoms. Therefore, a serological screening by autoantibody testing is required for early detection. Identified by screening, the prevalence of CD and AIT is reported to be up to 10-fold higher in young patients with type-1 diabetes than in healthy children. Up to now, no uniform recommendations exist regarding a standardized screening procedure as well as the treatment of patients with clinically asymptomatic disorder and evidence of autoimmunity. A delay in the detection of associated diseases, however, may lead to clinical relevant, but otherwise preventable complications.
Literatur
-
1
Acerini C L, Ahmed M L, Ross K M, Sullivan P B, Bird G, Dunger D B.
Coeliac disease in children and adolescents with IDDM: clinical characteristics and response to gluten-free diet.
Diabetic Med.
1998;
15
38-44
-
2
Amin R, Murphy N, Edge J, Ahmed M L, Acerini C L, Dunger D B.
A longitudinal study of the effect of a gluten-free diet on glycemic control and weight gain in subjects with type 1 diabetes and coeliac disease.
Diabetes Care.
2002;
25
1117-1122
-
3
Baloch Z, Carayon P, Conte-Devolx B. et al .
Laboratory Medicine Practice Guidelines. Laboratory support for the diagnosis and monitoring of thyroid disease.
Thyroid.
2003;
13
3-126
-
4
Barera G, Bonfanti R, Viscardi M. et al .
Occurrence of celiac disease after oncet of type 1 diabetes: a six-year prospective longitudinal study.
Pediatrics.
2002;
109
833-838
-
5
Chase H P, Garg S K, Cockerham R S. et al .
Thyroid hormone replacement and growth in children with subclinical hypothyroidism and diabetes.
Diabetic Med.
1990;
7
299-303
-
6
Cooper D S.
Subclinical hypothyroidism.
N Engl J Med.
2001;
345
260-265
-
7
Corrao G, Corazza G R, Bagnardi V. et al .
Mortality in patients with coeliac disease and their relatives: a cohort study.
Lancet.
2001;
358
356-361
-
8
Cronin C C, Shanahan F.
Exploring the iceberg - the spectrum of celiac disease.
Am J Gastroenterol.
2003;
98
518-519
-
9
Dayan C M, Daniels H D.
Chronic autoimmune thyroiditis.
N Engl J Med.
1996;
335
99-107
-
10
Delco F, El-Serag H B, Sonnenberg A.
Celiac sprue among US military veterans: associated disorders and clinical manifestations.
Dig Dis Sci.
1999;
44
966-972
-
11
Dittmar M, Kahaly G J.
Polyglandular autoimmune syndromes: immunogenetics and long-term follow-up.
J Clin Endocrinol Metab.
2003;
88
2983-2992
-
12
Gärtner R, Gasnier B C, Dietrich J W, Krebs B, Angstwurm M W.
Selenium supplementation in patients with autoimmune thyroiditis decreases thyroid peroxidase antibodies concentrations.
J Clin Endocrinol Metab.
2002;
87
1687-1691
-
13
Holl R W, Böhm B, Loos U. et al .
Thyroid autoimmunity in children and adolescents with type 1 diabetes mellitus. Effect of age, gender and HLA type.
Horm Res.
1999;
52
113-118
-
14
Hollowell J G, Staehling N W, Flanders W D. et al .
Serum TSH, T4, and thyroid antibodies in the United States population (1988 to 1994): National Health and Nutrition Examination Survey (NHANES III).
J Clin Endocrinol Metab.
2002;
87
489-499
-
15
Holmes G T.
Screening for coeliac disease in type 1 diabetes.
Arch Dis Child.
2002;
87
495-499
-
16 ISPAD Consensus Guidelines for the Management of Type 1 Diabetes Mellitus in Children and Adolescents. Consensus Guidelines 2000. Publ. Medforum, Zeist, Netherlands
-
17
Kordonouri O, Deiss D, Danne T.
Wesentliche assoziierte Erkrankungen beim Typ 1 Diabetes mellitus im Kindes- und Jugendalter. Diagnostik und Therapie der Zöliakie sowie weiterer Autoimmunendokrinopathien (Thyreoiditis, M. Addison).
Kinder- und Jugendarzt.
2001;
6
498-502
-
18
Kordonouri O, Dieterich W, Schuppan D. et al .
Autoantibodies to tissue transglutaminase are sensitive serological parameters for detecting silent coeliac disease in patients with type 1 diabetes mellitus.
Diabetic Med.
2000;
17
441-444
-
19
Kordonouri O, Klinghammer A, Lang E B, Grüters-Kieslich A, Grabert M, Holl R W.
Thyroid autoimmunity in children and adolescents with type 1 diabetes mellitus: a multicenter survey.
Diabetes Care.
2002;
25
1346-1350
-
20
Lorini R, dŽAnnunzio G, Vitali L. et al .
IDDM and autoimmune thyroid disease in pediatric age group.
J Pediatr Endocrinol Metab.
1996;
9
89-94
(Suppl 1)
-
21
Marsh M N.
Gluten, major histocompatibility complex, and the small intestine. A molecular and immunologic approach to the spectrum of gluten sensitivity („celiac sprue”).
Gastroenterology.
1992;
102
330-354
-
22
McDermott M T, Richway E C.
Subclinical hypothyroidism is mild thyroid failure and should be treated.
J Clin Endocrinol Metab.
2001;
86
4585-4590
-
23
Mohn A, Cerruto M, Lafusco D. et al .
Celiac disease in children and adolescents with type 1 diabetes: importance of hypoglycemia.
J Pediatr Gastroenterol Nutr.
2001;
32
37-40
-
24
Mohn A, Di Michele S, Di Luzio R, Tumini S, Chiarelli F.
The effect of subclinical hypothyroidism on metabolic control in children and adolescents with type 1 diabetes mellitus.
Diabetic Med.
2002;
19
70-73
-
25
Murray J A.
The widening spectrum of celiac disease.
Am J Clin Nutr.
1999;
69
354-365
-
26
Not T, Tommasini A, Tonini G. et al .
Undiagnosed coeliac disease and risk of autoimmune disorders in subjects with type 1 diabetes mellitus.
Diabetologia.
2001;
44
151-155
-
27
O’Connor T M, Cronin C C, Loane J F. et al .
Type 1 diabetes mellitus, coeliac disease, and lymphoma: a report of four cases.
Diabetic Med.
1999;
16
614-617
-
28
Padberg S, Heller K, Usadel K H, Schumm-Draeger P M.
One-year prophylactic treatment of euthyroid Hashimoto’s thyroiditis patients with levothyroxine: is there a benefit?.
Thyroid.
2001;
11
249-255
-
29
Saukkonen T, Vaisanen S, Akerblom H K, Savilahti E.
Coeliac disease in children and adolescents with type 1 diabetes: a study of growth, glycaemic control, and experiences of families.
Acta Paediatrica.
2002;
91
297-302
-
30
Westman E, Ambler G R, Royle M, Peat J, Chan A.
Children with coeliac disease and insulin dependent diabetes mellitus - growth, diabetes control and dietary intake.
J Pediatr Endocrinol Metab.
1999;
12
433-442
Priv.-Doz. Dr. med. Olga Kordonouri
Klinik für Allgemeine Pädiatrie, Otto-Heubner-Centrum für Kinder- und Jugendmedizin, Charité Universitätsmedizin Berlin, CVK
Augustenburger Platz 1
13353 Berlin
Telefon: +49/30/450566181
Fax: +49/30/450566916
eMail: olga.kordonouri@charite.de
