Glucocorticoid Therapy in Children

Elders, M. Joycelyn; Wingfield, Barbara S; McNatt, M; Clarke, James S.; Hughes, Edwin R.

doi:10.1001/archpedi.1975.02120490011005

Cited by 100 publications

(19 citation statements)

References 18 publications

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“…Wolthers et al [3]reported that administration of GH reversed the glucocorticoid induced protein catabolic effect detected in the present study, which is in accordance with other reports [1, 2, 4, 17]. A consistent finding in human studies is decreased IGF-I bioactivity in parallel with the protein catabolic effects of pharmacological doses of glucocorticoids [10, 12, 19, 20]. The exact nature of this decreased IGF-I bioactivity with unchanged/increased total IGF-I levels is unclarified.…”

Section: Discussionsupporting

confidence: 93%

“…Moreover, serum total IGF-I concentrations are normal or even elevated after both short-term and more prolonged exposure to glucocorticoids [1, 2, 5, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18]. Several studies have, however, shown reduced serum IGF bioactivity following glucocorticoid administration [10, 12, 19, 20]. This reduced bioactivity was not detectable when glucocorticoids were added to normal serum, which suggests the effect to depend on the generation of endogenous inhibitors [10].…”

Section: Introductionmentioning

confidence: 99%

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No Influence of Prednisolone on IGFBP-3 Proteolysis in Healthy Young Men

et al. 2001

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Aims: The impact of growth hormone (GH) and prednisolone on the GH/insulin-like growth factor (IGF) axis with special emphasis on IGF binding protein-3 (IGFBP-3) proteolysis was studied in 8 healthy adults in a double-blind cross-over study with four periods: (1) placebo; (2) s.c. GH 0.1 IU/kg/day; (3) oral prednisolone 50 mg/day, and (4) co-administration of GH and prednisolone. Methods: Each treatment period lasted for 4 days followed by a washout period of 10 days. We measured IGF-I, IGF-II, IGFBP-1, IGFBP-2, IGFBP-3 by immunoassays, IGFBP-3 by Western ligand blotting (WLB) and finally in vitro IGFBP-3 proteolysis by a ¹²⁵I-IGFBP-3 degradation assay. Results: IGF-I levels increased by 99% during GH administration and 67% during co-administration of GH and prednisolone (p < 0.0005), whereas no significant change was seen during prednisolone alone. IGFBP-1 levels decreased 55% during the prednisolone period (p < 0.002), but the between period changes were not significant (p < 0.1). IGFBP-2 decreased 33% during co-administration of GH and prednisolone (p < 0.002). IGFBP-3 increased 12% during GH and 7% during co-administration of GH and prednisolone (p < 0.003 and p < 0.03 compared to placebo, respectively), whereas prednisolone alone induced no significant changes. IGFBP-3 measured by WLB did not change significantly, neither did IGFBP-3 proteolysis. Conclusions: Prednisolone administration induces only minimal changes in circulating components of the IGF axis and is not accompanied by alterations in IGFBP-3 proteolysis. This indicates that the metabolic effects of glucocorticoids do not depend on serum IGF-I.

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Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

No Influence of Prednisolone on IGFBP-3 Proteolysis in Healthy Young Men

et al. 2001

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“…Normal levels of somatomedins have been described in patients with Cushing syndrome and those treated with GC [20]. However, such patients may have a reduction in the biological activity of somatomedin [20, 21]. The negative correlation between pretreatment IGF-1 levels and height velocity in response to treatment demonstrates the importance of anomalies of the GH-IGF-1 axis in understanding abnormal growth in these patients.…”

Section: Discussionmentioning

confidence: 99%

Treatment of Juvenile Rheumatoid Arthritis with Growth Hormone

2000

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Severe growth retardation and profoundly altered body composition are observed in children with juvenile chronic arthritis receiving glucocorticoids. This study assessed the effects of growth hormone (GH) on height velocity, body composition and bone density. Fourteen patients were treated with GH (1.4 U/kg/week) for 1 year and then studied for a 2nd year off GH. The treatment increased insulin-like growth factor 1 and insulin-like growth factor binding protein 3 plasma levels. All patients showed an increase in height velocity. Lean body mass increased by 12%. After the cessation of GH therapy, height velocity fell to pretreatment values, and weight and fat mass increased markedly. Bone formation and resorption markers significantly increased during treatment and returned to pretreatment values after discontinuation of GH treatment. These results suggest that GH may partially counteract the adverse effects of glucocorticoids on growth and metabolism in patients with chronic inflammatory disease.

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“…In patients receiving alternate day corticosteroid therapy, somatomedin levels were noted to be higher on the days off steroids (14). Additionally, prednisone administration in pediatric renal allograft recipients resulted in a fall in somatomedin activity that was related to an increase in an inhibitor of somatomedin (16).…”

mentioning

confidence: 98%

“…Earlier clinical studies have also alluded to the possibility that corticosteroid associated growth retardation could be due to decreased somatomedin activity (14)(15)(16). In patients receiving alternate day corticosteroid therapy, somatomedin levels were noted to be higher on the days off steroids (14).…”

mentioning

confidence: 99%