Endocrinology and Metabolism Clinics of North America
GROWTH SUPPRESSION BY GLUCOCORTICOID THERAPY
Section snippets
MECHANISMS OF GROWTH SUPPRESSION BY GLUCOCORTICOIDS
The pathogenesis of growth suppression by GC is complex and multifactorial, involving several steps in the cascade of events leading to linear growth. During childhood, GH is necessary for epiphyseal growth and maturation. Pulsatile, primarily nocturnal release of pituitary GH (Fig. 1)3 occurs under the influence of interwoven hypothalamic stimulation [via growth hormone–releasing hormone (GHRH)] and inhibition (via somatostatin). In late childhood and adolescence, GH secretion is augmented by
EFFECTS OF INHALED CORTICOSTEROIDS ON GROWTH
Inhaled corticosteroids have significantly reduced the incidence of GC toxicity in children with severe asthma who were previously dependent on systemic steroid therapy. For these children, the benefits of reduced oral GC therapy clearly exceed possible risks of IC therapy. Increased appreciation of the primary role of inflammation in the pathophysiology of asthma and concerns about tolerance to the bronchodilation effects of inhaled beta-adrenergic receptor agonists have elevated IC as
DETECTION AND POTENTIAL TREATMENT OF GROWTH FAILURE IN CHILDREN TREATED WITH GLUCOCORTICOIDS
Accurate monitoring of linear growth depends on accurate measurement using a wall-mounted stadiometer and plotting of growth points on the height-versus-age growth curve. Meaningful determination of linear growth rates requires a minimum 3- to 4-month interval between careful measurements. Because of the variable nature of normal childhood growth and the overriding importance of adequate control of underlying illness, therapeutic decisions regarding dosing of GC should probably await 6 months
SUMMARY
Glucocorticoids exert multiple growth-suppressing effects, interfering with endocrine (e.g., endogenous GH secretion) and metabolic (e.g., bone formation, nitrogen retention, collagen formation) processes essential for normal growth. Relatively small oral doses of daily exogenous GC, alternate-day oral GC therapy, and even IC are capable of slowing growth in some children. These growth-inhibiting and catabolic effects of GC can be variably counterbalanced by GH therapy. With regard to linear
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Address reprint requests to David B. Allen, MD, Professor of Pediatrics, University of Wisconsin Children's Hospital, Department of Pediatrics, 600 Highland Avenue, Madison, WI 53792–4108