Catch-Up Growth and Corticosteroids: A Focus on Mechanisms and Clinical Conditions



Adrenal cortex produces three types of corticosteroids: mineralocorticoids, glucocorticoids, and androgens. Glucocorticoids suppress and androgens accelerate growth in length/height, while mineralocorticoids have no essential influence on growth. Excess of glucocorticoids delays bone maturation, which favors the chance of good catch-up growth after the source of excess glucocorticoids has been removed. Pituitary overproduction of ACTH (Cushing’s disease) and adrenal cortisol-producing tumors represent the endogenous states of glucocorticoid excess, but adrenal androgen overproduction may also be present in these conditions and affect the growth pattern. Systemic or local glucocorticoid treatment for medical reasons (asthma, juvenile rheumatoid arthritis, nephrotic syndrome, inflammatory bowel disease, and immunosuppression after organ transplantations) can cause Cushingoid features with obesity and poor growth in length/height. These conditions represent pure glucocorticoid excess as adrenal androgen production is usually suppressed. Most children born small for gestational age (SGA) catch up during the first few years of life, but about 10% do not catch up and will be short as adults. There is some evidence that SGA children without catch-up growth may have higher activity of the hypothalamic–pituitary–adrenal (HPA) axis than those who catch up. Hyperandrogenism accelerates bone maturation causing advancement of bone age. After the cause of adrenal hyperandrogenism has been removed, deceleration of growth in height (catch-down growth) is seen. If hyperandrogenism has lasted for a long time, some growth potential is often lost resulting in lower than expected adult height. Two main hypotheses have been developed to explain catch-up growth, the neuroendocrine and the growth plate hypothesis. Neither of these theories can fully explain the catch-up growth phenomenon in children, and the biochemical basis for catch-up growth is unclear. Although it is tempting to speculate that the somatotrophic axis would somehow be involved in the regulation of catch-up growth, there is no convincing evidence of an overt increase in growth hormone secretion or of sustained elevation of IGF levels during catch-up growth. The possible role of local alterations in the function of IGF receptors, IGF-binding proteins, or intracellular signal transduction pathways related to chondrocyte proliferation and apoptosis at the growth plate level are more difficult to study. Evidence is accumulating to support the role of intrinsic growth plate properties and enhanced chondrocyte proliferation as the basis of the intriguing phenomenon of catch-up growth.


Growth Plate Adrenal Tumor Juvenile Rheumatoid Arthritis Adrenal Androgen Growth Plate Chondrocytes 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



Adrenocorticotropic hormone


Congenital virilizing adrenal hyperplasia




Dehydroepiandrosterone sulfate




11β-Hydroxysteroid dehydrogenase type 2


Insulin-like growth factor


Intrauterine growth retardation


Standard deviation score


Small for gestational age


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© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  1. 1.Department of PediatricsUniversity of Eastern Finland and Kuopio University HospitalKuopioFinland
  2. 2.Department of PediatricsKymenlaakso Central HospitalKotkaFinland

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