Glucocorticoid-associated growth failure: Mechanisms and potential reversal

Through a variety of mechanisms, glucocorticoids exert potent growth suppressing effects. Primarily through the use of inhaled corticosteroid preparations to treat asthma, the number of children exposed to exogenous glucocorticoids is rapidly increasing. Although growth failure is commonly experienced by children receiving long term oral glucocorticoid therapy, the effect of inhaled corticosteroids on growth remains an unresolved and controversial issue. In situations where glucocorticoid therapy and its attendant adverse effects on growth are unavoidable, inhibitory effects of glucocorticoids on pulsatile growth hormone secretion, insulin like growth factor-1 bioactivity, and collagen synthesis could theoretically be compensated for by exogenous growth hormone therapy. This article reviews the pathophysiology of growth suppression by glucocorticoids, the information currently available regarding the effects of chronic inhaled corticosteroids on growth, and the effectiveness of growth hormone therapy in reversing glucocorticoid-induced growth failure.