The effects of anabolic steroids on growth, body composition, and metabolism in boys with chronic renal failure on regular hemodialysis

Eight boys aged 9.5 to 17 years, on regular hemodialysis for chronic renal failure, were treated for 0.4 to 1.3 years with the anabolic steroid oxandrolone. The effects on linear growth, skeletal maturation, cell mass, and the fasting levels and response to intravenous glucose of BG, IRI, NEFA, BCAA, and IRG were measured. Following treatment there was a significant increase in mean growth velocity, growth velocity standard deviation score related to bone age, and cell mass. Overall skeletal maturation was not accelerated, and only a small advance in pubertal status was seen. There was a descrease in fasting levels of BG and NEFA; fasting BCAA and IRG were increased. The response to intravenous glucose was altered; there was a decrease in peak BG response, an increase in peak IRI response, and a more marked fall in plasma NEFA and BCAA levels. Fasting IRG levels correlated with fasting BG levels, and fell significantly following intravenous glucose both before and after treatment. Hepatotoxicity, which was reversible, was seen in a ninth boy who did not complete the study. The only other side effect, salt and water retention, was controlled by a reduction in oxandrolone dosage. These preliminary results suggest that anabolic steroids may be useful to stimulate anabolism and growth in uremic children, and that their effect is mediated by an increase in insulin secretion and/or an improvement in tissue sensitivity to insulin. Further studies with careful monitoring are required to substantiate the effect on final height and the risks involved.