Confusion over labs ie IgA SO

[Karlen]

My GI Dr ran the following tests re possible celiac disease. I have had many years of IBS and wonder if it's really Celiac disease.  I also have adrenal insufficiency (Addison's) on daily Hydrocortisone. 

Here are my labs: 

IgA - So -   57 mg/dL

Date: Aug 18, 2021 11:38 a.m. CDT Reference Range: 68-408

And 

Tissue Transglutaminase Ab IgA

< 2 Units/mL

Date: Aug 18, 2021 11:38 a.m. CDT Reference Range: 0-3

 

Based on the first test above to me looks like I have low IgA SO. I don't know what IgA SO is.  Have looked online to try and figure this out.  

 

Any info would help.  

Thank you

 

[trents]

Welcome to the forum, Karlen!

My guess would be that the "IGA-So" is a measure of total IGA. And yes, it does appear to be low which can skew other IGA antibody test values.

Your physician only ran one of the several antibody tests that can be run for celiac disease diagnosis. He ran the TTG-IGA test which is the most commonly run celiac diagnosis test. It is the most specific for celiac disease but not the most sensitive which means it sometimes misses people who actually do have celiac disease. By any chance, were you already trying to eat gluten free before the blood work was done? If so, that can invalidate the testing.

Here is an article that discusses the various blood antibody tests that can be run to check for celiac disease: https://celiac.org/about-celiac-disease/screening-and-diagnosis/screening/

I think you should consider being retested with a more complete antibody panel. And make sure you have been eating normal amounts of gluten  for about two months before testing. Normal, meaning consuming daily an amount of gluten equivalent to two slices of wheat bread.

You might also pursue a biopsy of the small bowel lining done with an upper GI endoscopy. That is the gold standard. Celiac disease causes damage to the small bowel lining that sometimes is severe enough to be obvious during the scoping but otherwise must be analyzed in by a lab.

Another possibility is that you have NCGS (Non Celiac Gluten Sensitivity) for which there is not yet a test. It is diagnosed by having celiac-like symptoms but negative blood antibody test results and/or negative biopsy.

[Karlen]

Thank u for that info. 🥴

[prissy1979]

Good morning,

I also have Addison's disease and I also have Hashimoto's thyroiditis. Can you tell me what type of symptoms you may be experiencing? I am fixing to be tested, but I feel horrible all the time. It is rare that I find another Addisonian, so I am curious if your symptoms are comparable to mine. Thanks.

[Karlen]

3 hours ago, prissy1979 said:

Good morning,

I also have Addison's disease and I also have Hashimoto's thyroiditis. Can you tell me what type of symptoms you may be experiencing? I am fixing to be tested, but I feel horrible all the time. It is rare that I find another Addisonian, so I am curious if your symptoms are comparable to mine. Thanks.

Hi - I have exhaustion all the time, pain, any extra stress or minor Illness I take double of my daily Hydrocortisone dose.  I also have bronchiectasis, fibromyalgia, GERD (after Nissan Fundoplicatuon after many years of being on RX Gerd meds.  I also have IBS symptoms and have wondered if it's Celiac disease.  My diet is further complicated by dysphagia (I have to have nectar thick liquids and chopped soft diet.  I also have a recurrence of interstitial cystitis. To help the IBS and IC I keep a food/drink symptom diary to find out things that cause flare of IBS or IC.  So far list of adverse foods for me: greasy fatty deep fried foods, sugar, acidic drinks or food, cruciferous vegetables, spicy foods etc.  

I have what they call Secondary Adrenal Insufficiency as the adrenal insufficiency occurred over decades when I had chronic bronchitis, sinus infections, pneumonia etc and was always put on steroid bursts.  Over the years my adrenal glands atrophied and stopped making cortisol.  I have had the ACTH test which verified the adrenal gland shut down.  Unfortunately I have to be very careful not to catch any virus or flu etc as regular oral RX antibiotics and steroid burst dove work for me.  If I get bronchitis or bronchial ling infection I end up in hospital for a week on IV steroids and multiple IV antibiotics and respiratory therapy.  

 

[skydvr18]

Karlen, I was "officially" diagnosed with celiac today - with a very, very similar situation as yours.  I also have secondary adrenal insufficiency - mine was considered secondary because both my baseline cortisol and ACTH levels were low, and my adrenals responded to the ACTH stim test.  If your adrenals are damaged, have they not changed it from secondary to primary (Addison's)?  I haven't read up on it in a while - doc put on hydrocortisone & more or less said "go away, I've done my job."

My gastroenterologist did the biopsy first - my dentist insisted I had GERD due to enamel loss (now know it was caused by celiac), so my gastroenterologist said, just before the EGD, "I'm just going to take a quick look, come right back out."  I replied, "Oh, you're not going to do biopsies to look for something like celiac?"  She replied, "Yeah, I may."  She did; biopsy said severe villous atrophy, but not significant intraepithelial lymphocytes, so correlate with serology.  So she first ordered serum IGA, TTG IGA, & DGA (?) IGA.  My serum IGA was low as well; the others were normal, but because my IGA was low, it made the other results unreliable (false negatives).  My results:

IGA, serum = 39, ref range 90-386

TTG IGA, <2, ref range 0-3

deamidated giliadin abs, iga 2, ref range 0-19

So the last two DON'T indicate celiac, but looking at my serum iga and seeing it's low, we know the other two are false negatives.  So she ordered the same tests that were IGG based (serum IGG, TTG IGG, & DGA(?) IGG).   It was a nightmare with the lab - they would only draw the TTG IGG:

10, ref range 0-5

The lab refused to draw the other two (serum IGG, DGA(?) IGG), insisting they'd already drawn them.  So today I e-mailed her office to see if she would send a third order to the hospital.  The lab still insists they've drawn them & results aren't back, so she replied to the nurse,

"His TTG IgG is elevated and c/w (consistent with?) celiac

No reason to repeat them

He has celiac disease"

So she knew 5 days ago, but waited until today, my 40th birthday, to tell me.  It's been a hellish 5 days thinking "it's probably celiac, but she hasn't told me 'you have celiac' yet - so I guess it could be something else."  Thanks doc

So as Trents said, you might ask for the IGG-based labs or go straight to EGD with biopsy.  Only problem with EGD & biopsy without labwork:  same doc dropped the ball in 2015, because she didn't draw labs and only took biopsies from the distal duodenum (not the duodenal bulb).  Biopsies normal, but because celiac is patchy & more is in the duodenal bulb, she probably would have done a better job with the biopsies had she done labs first.  

Interesting how many of us here have Addison's / secondary adrenal insufficiency!  Prissy, do you know if your Addison's is related to celiac?  I'm just now finding out my osteopenia & enamel loss (like iron-deficiency anemia) are because of celiac, not anti-seizure medicine and GERD as other doctors said.

Nice to meet everyone, sorry for my rant!

[Scott Adams]

Here is an older article on the connection between celiac disease and Addison's:

https://www.celiac.com/celiac-disease/connection-seen-between-celiac-and-addison's-disease-r1208/ 

 

[Karlen]

On 8/25/2021 at 11:13 PM, skydvr18 said:

Karlen, I was "officially" diagnosed with celiac today - with a very, very similar situation as yours.  I also have secondary adrenal insufficiency - mine was considered secondary because both my baseline cortisol and ACTH levels were low, and my adrenals responded to the ACTH stim test.  If your adrenals are damaged, have they not changed it from secondary to primary (Addison's)?  I haven't read up on it in a while - doc put on hydrocortisone & more or less said "go away, I've done my job."

My gastroenterologist did the biopsy first - my dentist insisted I had GERD due to enamel loss (now know it was caused by celiac), so my gastroenterologist said, just before the EGD, "I'm just going to take a quick look, come right back out."  I replied, "Oh, you're not going to do biopsies to look for something like celiac?"  She replied, "Yeah, I may."  She did; biopsy said severe villous atrophy, but not significant intraepithelial lymphocytes, so correlate with serology.  So she first ordered serum IGA, TTG IGA, & DGA (?) IGA.  My serum IGA was low as well; the others were normal, but because my IGA was low, it made the other results unreliable (false negatives).  My results:

IGA, serum = 39, ref range 90-386

TTG IGA, <2, ref range 0-3

deamidated giliadin abs, iga 2, ref range 0-19

So the last two DON'T indicate celiac, but looking at my serum iga and seeing it's low, we know the other two are false negatives.  So she ordered the same tests that were IGG based (serum IGG, TTG IGG, & DGA(?) IGG).   It was a nightmare with the lab - they would only draw the TTG IGG:

10, ref range 0-5

The lab refused to draw the other two (serum IGG, DGA(?) IGG), insisting they'd already drawn them.  So today I e-mailed her office to see if she would send a third order to the hospital.  The lab still insists they've drawn them & results aren't back, so she replied to the nurse,

"His TTG IgG is elevated and c/w (consistent with?) celiac

No reason to repeat them

He has celiac disease"

So she knew 5 days ago, but waited until today, my 40th birthday, to tell me.  It's been a hellish 5 days thinking "it's probably celiac, but she hasn't told me 'you have celiac' yet - so I guess it could be something else."  Thanks doc

So as Trents said, you might ask for the IGG-based labs or go straight to EGD with biopsy.  Only problem with EGD & biopsy without labwork:  same doc dropped the ball in 2015, because she didn't draw labs and only took biopsies from the distal duodenum (not the duodenal bulb).  Biopsies normal, but because celiac is patchy & more is in the duodenal bulb, she probably would have done a better job with the biopsies had she done labs first.  

Interesting how many of us here have Addison's / secondary adrenal insufficiency!  Prissy, do you know if your Addison's is related to celiac?  I'm just now finding out my osteopenia & enamel loss (like iron-deficiency anemia) are because of celiac, not anti-seizure medicine and GERD as other doctors said.

Nice to meet everyone, sorry for my rant!

Thank you for this info.