The effect of administered corticosteroids on the growth of children

Abstract

SummaryThe growth-inhibiting effect of exogenous corticosteroids has been reported in many papers. Most of them have concerned the clinical problems of asthma and rheumatoid arthritis but it is probable that the underlying disease is relatively unimportant in determining the effect on growth. Steroid therapy on alternate days seems to produce less undesirable effects than steroid treatment every day and corticotrophin may be preferable.Although the mechanisms are uncertain it seems likely that the action is peripheral and certainly exogenous growth hormone does not prevent the steroid effect. A minimal dosage of corticosteroids should always be used in replacement therapy for hypopituitarism.THE harmful effects of glucocorticoids on growth are well known to all clinicians who treat children. In general, this is recognized in the management of bronchial asthma, rheumatoid arthritis and the nephrotic syndrome, as these are the most common childhood disorders that are treated with long-term corticosteroids. This poor growth may also be associated with a degree of maturational delay, which is usually observed as delayed skeletal age. The mechanism of this effect on growth and how to prevent it is not known. Investigation of the various conditions in which it occurs can, however, give us valuable insight into the pathogenesis of the poor growth and perhaps suggest ways of avoiding it.Growth retardation has long been recognized as a feature of childhood Cushing's syndrome where the source of excessive glucocorticoids is endogenous. Prader, Tanner and von Harnack (1963) described a girl who had suffered with Cushing's syndrome from 4 months to 4 years of age, at which time an adrenal adenoma was removed. By the time of the operation she was 5 2 s.d. below the mean of stature for age although her weight was well above the mean. The growth velocity over the 2 years before the operation was 3 -2 cm/year but following the surgery it increased rapidly so that it was 17-8 cm/year during the subsequent year. Growth velocity remained above the Correspondence: M. A. Preece,

Rats Stunted by High-Dose Glucocorticoid Treatment Are Capable of Undergoing Catch-Up Growth after Fasting

“…Permanently stunted growth has also been observed in the human after high-dose glucocorticoid treatment (2) or after Cushing's syndrome (3). The absence of catchup growth in the recovery period has been attributed to a failure of response of target tissues to growth factors (4). That hypothesis is consistent with the existence in the rat of longstanding disturbances of cartilage ultrastructure (5), in vrtro cartilage sulfation (6).…”

“…It has been proposed that the changes in cartilage produced by growth suppressive levels of glucocorticoids in young animals and humans account for the failure of catch-up growth during recovery (2)(3)(4)(5). However, the results of the present experiments show that both soft tissues and skeletal tissues maintain the capability of supporting catch-up growth after cortisone-induced stunting.…”

IGFs and IGF-binding proteins in short children with steroid-dependent nephrotic syndrome on chronic glucocorticoids: changes with 1 year exogenous GH

“…Similarly, IGFBP-3, which is GH dependent, has also been reported as low, normal or increased in glucocorticoid-treated children (3, 9±12). Thus another mechanism has been postulated, namely that glucocorticosteroids may directly inhibit osteoblastic activity in bone and cartilage, inducing a state of IGF resistance affecting bone growth (10,13,14).…”

Clinical Management of Atopic Eczema with Pimecrolimus Cream 1% (Elidel®) in Paediatric Patients

“…As corticosteroids may enter the bloodstream when applied topically, in rare cases, growth may be affected following unrestricted prolonged use [8, 9,51,52,53,54]. …”