Long Term Corticosteroid Treatment and Growth

Besides the well-known side effects, long term corticosteroid treatment in pharmacological doses causes inhibition of statural growth in children. This is of special importance in asthmatic children, since their growth may be impaired by the disease itself. The degree of inhibition of growth depends on the type of corticosteroids used (the inhibition by synthetic derivatives is stronger than that by hydrocortisone), on the dosage, and on the duration of treatment. The mechanisms leading to an inhibition of growth are not fully understood: possibly the corticosteroids inhibit the release of growth hormone from the pituitary, or they antagonize the metabolic action of growth hormone peripherally. In an effort to avoid the growth-inhibiting effect of corticosteroids, different approaches have been tried: Replacement of corticosteroids by ACTH seems to have normalized the growth rate in some cases, but failed to do so in others. A final evaluation of the value of ACTH with respect to growth can therefore not yet be made. At the present time, therapy with corticosteroids at an alternate day schedule seems to be promising: the daily dosage is doubled, but the corticosteroids are given only every other day. Treated in this way, the patients observed so far, have been able to maintain a normal growth rate.