Growth suppression by glucocorticoid therapy.

Glucocorticoids exert multiple growth-suppressing effects, interfering with endocrine (e.g., endogenous GH secretion) and metabolic (e.g., bone formation, nitrogen retention, collagen formation) processes essential for normal growth. Relatively small oral doses of daily exogenous GC, alternate-day oral GC therapy, and even IC are capable of slowing growth in some children. These growth-inhibiting and catabolic effects of GC can be variably counterbalanced by GH therapy. With regard to linear growth, GH responsiveness depends on the GC dose and severity of underlying GC-dependent disease. Short-term risks of combined GH and GC therapy are low; longer term risks (e.g., reduced allograft function, survival, or both; increased underlying disease activity; oncologic risk) require further study. GH therapy in GC-dependent children remains experimental; children considered for such treatment should be enrolled in studies that facilitate careful monitoring and collective data analysis.