The Assesment of Pubertal Timing in Pediatric Patients Diagnosed With Coeliac Disease

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Celiac Disease, Middle Upper Arm Circumference (MUAC), Pediatrics, Puberty, Tanner Staging


Aim:  Puberty disorders are observed in Celiac Disease (CD). In our study, we aimed to evaluate pubertal developmental stages, laboratory parameters according to pubertal staging, and anthropometric measurements in children and adolescents with CD.

Material-Method: The study was designed as cross-sectional and included patients with CD, aged 7-16 years, who applied to Adana City Training and Research Hospital Pediatric Gastroenterology 1 Outpatient clinic between 01.10.2022 and 31.12.2022. Tanner stages and hormonal parameters of the cases were recorded.

Results: Of the 108 patients included in the study, 39 (36.1%) were male and 69 (63.9%) were female. While 52 of the cases (48.1%) were Tanner stage 1, 15 (13.9%) were Tanner stage 2, 11 (10.2%) were Tanner stage 3, 7 (6.5%) were Tanner stage 4 and 23 (21.3%) were in Tanner stage 5. The mean age of the cases was 10.7±3.5 years, and the mean follow-up period was 3.7±2.5 years. When the sexes are separated, while the median height is 10.5 percentile (p) (0.01-94.1) for boys, the weight is 8.5 p (0.01-98.8), while the median height is 21.7 p (0.01-96.2) and the weight is 13.6 p (0.01-99.9)  for girls. When the patient groups were classified as prepubertal and pubertal according to pubertal stages, 51.9% (n= 56) of the patients were in the pubertal stage and 48.1% (n: 52) were in the prepubertal stage. Vitamin B12, folate, and ferritin levels were found to be lower in pubertal cases than in prepubertal cases (p=0.034, p<0.001, p=0.039, respectively). According to the evaluation, the sensitivity of the middle upper arm circumference (MUAC) cut-off point of 19.8 cm and above in estimating the pubertal stage was found to be 86.5% and the specificity as 78.6% (p<0.001). Mean age at menarche in menstruating patients was within the normal range with 12 ±1.09 years.

Conclusion: Although CD is at risk for delayed puberty, no delay in pubertal findings or gonadal insufficiency was found in our study. It has been shown that MUAC, which is important in terms of malnutrition screening, will also be important in predicting the onset of puberty. In addition, we recommend that close monitoring of blood levels is required in these patients due to the increase in vitamin needs especially in pubertal period.


Abdel-Rahman, S. M., Bi, C., & Thaete, K. (2017). Construction of Lambda, Mu, Sigma Values for Determining Mid-Upper Arm Circumference z Scores in U.S. Children Aged 2 Months Through 18 Years. Nutrition in Clinical Practice, 32(1), 68-76.

Bayrak, N. A., Volkan, B., Haliloglu, B., Kara, S. S., & Cayir, A. (2020). The effect of celiac disease and gluten-free diet on pubertal development: A two-center study. Journal of Pediatric Endocrinology and Metabolism, 33(3), 409-415.

Bona, G., Marinello, D., & Oderda, G. (2002). Mechanisms of Abnormal Puberty in Coeliac Disease. Hormone Research in Paediatrics, 57(2), 63-65.

Cakmak, E., Karakus, S., Demirpence, O., & Demet Coskun, B. (2018). Ovarian Reserve Assessment in Celiac Patients of Reproductive Age. Medical Science Monitor, 24, 1152-1157.

Dieli-Crimi, R., Cénit, M. C., & Núñez, C. (2015). The genetics of celiac disease: A comprehensive review of clinical implications. Journal of Autoimmunity, 64, 26-41.

Elias, C. F., & Purohit, D. (2013). Leptin signaling and circuits in puberty and fertility. Cellular and Molecular Life Sciences: CMLS, 70(5), 841-862.

Gasbarrini, A., Torre, E. S., Trivellini, C., De Carolis, S., Caruso, A., & Gasbarrini, G. (2000). Recurrent spontaneous abortion and intrauterine fetal growth retardation as symptoms of coeliac disease. The Lancet, 356(9227), 399-400.

Green, P. H. R., Stavropoulos, S. N., Panagi, S. G., Goldstein, S. L., McMahon, D. J., Absan, H., & Neugut, A. I. (2001). Characteristics of adult celiac disease in the USA: Results of a national survey. The American Journal of Gastroenterology, 96(1), 126-131.

Gruijters, M. J. G., Visser, J. A., Durlinger, A. L. L., & Themmen, A. P. N. (2003). Anti-Müllerian hormone and its role in ovarian function. Molecular and Cellular Endocrinology, 211(1-2), 85-90.

Jericho, H., & Guandalini, S. (2018a). Extra-Intestinal Manifestation of Celiac Disease in Children. Nutrients, 10(6), 755.

Jericho, H., & Guandalini, S. (2018b). Extra-Intestinal Manifestation of Celiac Disease in Children. Nutrients, 10(6), 755.

Khater, D. (2018). Endocrinopathies in celiac disease: When the endocrinologist sees what is invisible to the gastroenterologist. Acta Bio Medica Atenei Parmensis, 89(1), 117-121.

Kotze, L. M. S. (2004). Gynecologic and Obstetric Findings Related to Nutritional Status and Adherence to a Gluten-Free Diet in Brazilian Patients with Celiac Disease: Journal of Clinical Gastroenterology, 38(7), 567-574.

Lebwohl, B., Sanders, D. S., & Green, P. H. R. (2018). Coeliac disease. The Lancet, 391(10115), 70-81.

Mičetić-Turk, D., Vlaisavljević, V., Turk, E., & Pogačar, M. Š. (2019). Onset of menarche is not delayed in Slovenian patients with celiac disease. Journal of International Medical Research, 47(2), 815-822.

Mishra, K., Kumar, P., Kumar, R., Kaur, S., Basu, S., & Dutta, A. K. (2012). Assessment of sexual maturity in a cohort of adolescents with celiac disease on gluten-free diet. Indian Journal of Gastroenterology, 31(3), 130-132.

Neyzi, O., Bundak, R., Gökçay, G., Günöz, H., Furman, A., Darendeliler, F., & Baş, F. (2015). Reference Values for Weight, Height, Head Circumference, and Body Mass Index in Turkish Children. Journal of Clinical Research in Pediatric Endocrinology, 7(4), 280-293.

Özgör, B., & Selimoğlu, M. A. (2010). Coeliac disease and reproductive disorders. Scandinavian Journal of Gastroenterology, 45(4), 395-402.

Pedretti, M., Sbravati, F., Allegri, D., Labriola, F., Lombardo, V., Spisni, E., … Alvisi, P. (2021). Is the clinical pattern of pediatric celiac disease changing? A thirty-years real-life experience of an Italian center. Italian Journal of Pediatrics, 47(1), 235.

Roshanzamir, N., Zakeri, Z., Rostami-Nejad, M., Sadeghi, A., Pourhoseingholi, M.-A., Shahbakhsh, Y., … Rezaei-Tavirani, M. (2021). Prevalence of celiac disease in patients with atypical presentations. Arab Journal of Gastroenterology, 22(3), 220-223.

Sedlmeyer, I. L., & Palmert, M. R. (2002). Delayed Puberty: Analysis of a Large Case Series from an Academic Center. The Journal of Clinical Endocrinology & Metabolism, 87(4), 1613-1620.

Sferlazzas, C., Arrigo, T., Salzano, G., Pellegrino, S., La Fauci, G., Rulli, I., … De Luca, F. (2008). Menarcheal age in celiac disease may not be delayed and may be irrespective of age at diagnosis and dietary management. Journal of Endocrinological Investigation, 31(5), 432-435.

Tanner, J. M., & Whitehouse, R. H. (1976). Clinical longitudinal standards for height, weight, height velocity, weight velocity, and stages of puberty. Archives of Disease in Childhood, 51(3), 170-179.

Toscano, V., Conti, F. G., Anastasi, E., Mariani, P., Tiberti, C., Poggi, M., … Bonamico, M. (2000). Importance of Gluten in The Induction of Endocrine Autoantibodies and Organ Dysfunction in Adolescent Celiac Patients. American Journal of Gastroenterology, 95(7), 1742-1748.

Trovato, C. M., Montuori, M., Cucchiara, S., & Oliva, S. (2020). ESPGHAN ‘biopsy-sparing’ guidelines for celiac disease in children with low antitransglutaminase during COVID-19. European Journal of Gastroenterology & Hepatology, 32(12), 1523-1526.



How to Cite

GÜLCÜ TAŞKIN , D., & ATA, A. (2023). The Assesment of Pubertal Timing in Pediatric Patients Diagnosed With Coeliac Disease. GEVHER NESIBE JOURNAL OF MEDICAL AND HEALTH SCIENCES, 8(1), 238–244.