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Diabetes mellitus pós doença celíaca : considerações a propósito de um caso clínico
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Orientador(es)
Resumo(s)
A Doença Celíaca e a Diabetes Mellitus tipo 1 são duas patologias do foro auto-imune que ocorrem com reconhecida frequência em idade pediátrica. Embora inicialmente estudadas individualmente, permitindo os contributos da investigação básica e clínica uma maior compreensão da sua etiopatogénese, fisiopatologia e tratamento, recentemente tem-se assistido a um interesse crescente da sua abordagem integrada.
De facto, tem sido reportada uma elevada prevalência e incidência da co-ocorrência destas duas patologias, sobretudo da ocorrência de Doença Celiaca (maioritariamente assintomática) no contexto da Diabetes Mellitus Tipo I, o que não surpreenderá face à reconhecida agregação da patologia auto-imune.
A par da sua caracterização clínica, tanto na criança como no adulto e respectivo impacto na qualidade de vida, foram elucidados ou sugeridos alguns mecanismos genéticos e etiopatogénicos comuns subjacentes. Entre outras implicações potenciais de uma adequada caracterização da associação destas duas entidades, será possível fundamentar futuramente uma adequada estratégia de rastreio e de abordagem, na perspectiva de custo-benefício.
Apresenta-se um caso clínico ilustrativo da expressão clínica da co-ocorrência da Doença Celíaca e da Diabetes Mellitus tipo 1 em idade pediátrica (tendo a particularidade menos comum da ocorrência inicial da Doença Celíaca seguida do diagnóstico de Diabetes Mellitus), com subsequente revisão da literatura, comentando-se os seus aspectos mais relevantes.
Celiac Disease and Diabetes Mellitus type 1 are two auto-immune diseases that frequently co-occur in the pediatric population. Though initially studied as separate entities, they have recently been addressed collectively, with clinical and basic investigation allowing for a better understanding of its etiopathogenesis, physiopathology and treatment. Thus, an integrated approach is increasingly recognized as relevant. In fact, a high prevalence and incidence has been reported, concerning the co-occurrence of both diseases, particularly the occurrence of Celiac Disease (mostly asymptomatic) in diabetic patients. This is not surprising, considering that auto-immune pathology tends to appear in multiple complex associations. Besides the characterization of their clinical expression and impact in the quality of life, both in children and adults, some common genetic and etipathogenic mechanisms have been unmasked. Amongst other potential implications of a thorough comprehension of these two diseases, a screening strategy and a cost-effective approach of the association(s) may be achieved. This paper describes an illustrative clinical case, concerning the co-occurrence of Celiac Disease and Diabetes Mellitus type 1 at paediatric age (with the less common peculiarity of Celiac Disease appearing first) and respective literature review, further emphasizing its most relevant features.
Celiac Disease and Diabetes Mellitus type 1 are two auto-immune diseases that frequently co-occur in the pediatric population. Though initially studied as separate entities, they have recently been addressed collectively, with clinical and basic investigation allowing for a better understanding of its etiopathogenesis, physiopathology and treatment. Thus, an integrated approach is increasingly recognized as relevant. In fact, a high prevalence and incidence has been reported, concerning the co-occurrence of both diseases, particularly the occurrence of Celiac Disease (mostly asymptomatic) in diabetic patients. This is not surprising, considering that auto-immune pathology tends to appear in multiple complex associations. Besides the characterization of their clinical expression and impact in the quality of life, both in children and adults, some common genetic and etipathogenic mechanisms have been unmasked. Amongst other potential implications of a thorough comprehension of these two diseases, a screening strategy and a cost-effective approach of the association(s) may be achieved. This paper describes an illustrative clinical case, concerning the co-occurrence of Celiac Disease and Diabetes Mellitus type 1 at paediatric age (with the less common peculiarity of Celiac Disease appearing first) and respective literature review, further emphasizing its most relevant features.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2017
Palavras-chave
Doença celíaca Diabetes mellitus tipo 1 Dieta sem glúten Rastreio Pediatria