INTESTINAL ABSORPTION AND AUTOIMMUNITY IN ENDOCRINE DISORDERS

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Abstract
Thirty‐two patients with endocrine disorders were studied from gastroenterological and immunological points of view. Gastritis was found in 18 patients. It was atrophic in ten patients. Two of the latter had pernicious anemia with idiopathic hypoparathyroidism. Jejunal biopsy revealed a normal mucosa in 20 patients, an increase of “inflammatory” cells in four and villous alterations in six. Three of the latter had spontaneous hypothyroidism and two signs of autoimmune thyroiditis. A general malabsorption syndrome was present in eight patients, one had only steatorrhea and one possibly selective malabsorption of vitamin B12. Of 19 patients with thyroid disease alone or in combination with other endocrine disorders seven showed signs of malabsorption, six of whom also had villous alterations. Villous alterations were associated with immunological disturbances, except for one patient who had postoperative hypothyroidism. They did not respond to endocrine treatment nor to treatment with gluten‐free diet, except for the patient without immunological changes. Distinct edema of muscularis mucosae was visible in 13 out of 16 patients with hypothyroidism. Malabsorption and villous changes in thyroid disease may be due to 1. myxedematous changes; 2. altered motility; and 3. autoimmune phenomena. Of 12 patients with hypoparathyroidism alone or in combination with other endocrine disorders four had signs of malabsorption but only one with concomitant hypothyroidism and high thyroid antibody titers had villous alterations. Correction of calcium metabolism in three patients resulted in improvement of steatorrhea in all but the one with concomitant thyroid disease. This may point to a purely functional relationship between absorption and calcium metabolism.

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