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August 8, 2003

Research: Causes and Prevention

Question from Scotland, United Kingdom:

Both my children have type 1 diabetes, and while no other relative on either side of the family has either type 1 or type 2, the children's father was discovered to have carcinoid tumours which may also have metastasized to the liver. if this is a neuroendocrine disorder, does my husband having it have implications for the children? Is there a genetic link? Searching for information on carcinoid tumours, I found a piece of research from Finland in 1989, stating that 92% of children with type 1 diabetes and islet cell antibodies were found to have antibodies also to gastrointestinal carcinoid tumours. Might this provide an explanation, or identify a risk, in the case of our children, or is this just coincidence? Should I raise it with their doctors?

Answer:

The Finnish paper to which you referred came from an era when antibody testing in autoimmune disease was far less specific than it is today. Whilst these results were probably a technical aberration and the study has not been repeated, there is nonetheless some evidence of cross reactivity between islet cell antibodies and carcinoid cell antibodies. More importantly though, the association between type�1A (autoimmune) diabetes seems to be exceedingly rare, and related to this I could find no figures for the likelihood of either of your sons developing carcinoid tumors in later life. (See Miettinen A, Holthofer H, Kontiainen S, Miettinen M, Andersson LC. Antibodies against gastrointestinal carcinoid tumors in IDDM. Diabetes. 1989 May;38(5):667-9.

On the issue of further antibody testing, I don’t think that there is any justification for assaying carcinoid antibodies in your sons, but you should certainly discuss this with their endocrinologist because it is now recognised that this form of diabetes is quite often accompanied by other autoimmune conditions in the Autoimmune Polyglandular Syndrome Type II. Most centers now routinely test for hypothyroidism with a serum TSH test and for celiac disease which may occur in 8% of people with type�1 diabetes with an anti-transglutaminase test. An additional test for potential adrenal problems by anti 21-hydroxylase antibodies is sometimes considered a worthwhile precaution, but the incidence is less than 2%.

DOB