Ultrasound of Skin in Prednisolone-induced Short-terin Growth Suppression

Abstract

Reductions in thickness of cutis and subcutis may account for some of the lower leg growth suppression caused by systemic glucocorticoids.

Short-Term Growth after Withdrawal of Exogenous Glucocorticoids

“…A post-hoc analysis of data from a double-blind trial which compared 5 mg prednisolone once daily in the evening with placebo was performed [3]. The study consisted of run-in, treatment, wash-out and run-out periods of 1 week duration.…”

“…The inconsistency has to some extent reflected the lack of rigorous assessment of which wash-out duration may be the more appropriate. Since systemic glucocorticoids were introduced in children it has been known that after withdrawal of long-term treatment, catch up in height growth may occur [2, 3]. Whether catch-up may be seen after short-term growth suppression in school-age children has not been evaluated.…”

Prednisolone reduces the ability of serum to activate the IGF1 receptor in vitro without affecting circulating total or free IGF1

“…The present dose of prednisolone had a measurable impact on lower leg growth rate as assessed by knemometry (16). However, it should be emphasized that the demonstrated growth inhibition represents the combined effect of prednisolone on bone growth, knee and ankle joint ligaments, and tendons as well as shrinking of soft tissue (cutis, subcutis, and cartilage) over the knee and under the heel, and consequently, knemometry yields a composite measurement (41).…”

“…In an earlier publication based on the same study sample, it was possible to demonstrate by knemometry that 1 week of prednisolone treatment reduced lower leg growth rate in 17 of 20 children (P!0.01), from 0.58 mm/week during placebo to K0.23 mm/week during prednisolone treatment (16). The question Placebo Prednisolone Figure 1 The individual changes in serum bioactive IGF1 after 7 days of placebo or prednisolone (5 mg daily).…”

“…Acute illness requiring bed rest, hospitalization, or medication other than study medication would lead to exclusion from the trial. Data on the effect of oral prednisolone on changes in skin (15) and lower leg growth rate (16) have been published previously.…”