GLUCOCORTICOID-ASSOCIATED GROWTH FAILURE - MECHANISMS AND POTENTIAL REVERSAL

Through a variety of mechanisms, glucocorticoids exert potent growth s uppressing effects. Primarily through the use of inhaled corticosteroi d preparations to treat asthma, the number of children exposed to exog enous glucocorticoids is rapidly increasing. Although growth failure i s commonly experienced by children receiving long term oral glucocorti coid therapy, the effect of inhaled corticosteroids on growth remains an unresolved and controversial issue. In situations where glucocortic oid therapy and its attendant adverse effects on growth are unavoidabl e, inhibitory effects of glucocorticoids on pulsatile growth hormone s ecretion, insulin like growth factor-1 bioactivity, and collagen synth esis could theoretically be compensated for by exogenous growth hormon e therapy. This article reviews the pathophysiology of growth suppress ion by glucocorticoids, the information currently available regarding the effects of chronic inhaled corticosteroids on growth, and the effe ctiveness of growth hormone therapy in reversing glucocorticoid-induce d growth failure.