Endocrine Abstracts

Growth retardation is often observed in patients suffering from chronic diseases. Factors involved in growth delay are multiple. They can be divided into two groups: those due to the disease itself and those due to treatments. Under nutrition is frequently reported in chronically ill children, due to an imbalance between decreased caloric intake and increased energy requirements. Malabsorption, dehydration, chronic anaemia, inflammation also impact growth, as well as steroid therapy. The most frequent abnormality in these patients is a decrease in IGF1 levels. Low IGF1 levels are associated with impaired GH secretion or with normal or high GH levels. Several mechanisms underlie the decrease in IGF1 concentration: a functional GH deficiency, a resistance to GH mediated and/or an increase in IGF1 clearance due to a raised proteolysis of IGF-BP3. Besides the systemic effects on GH–IGF1 axis, a direct effect of under nutrition, cytokines and steroid therapy on chondrogenesis has also been reported.

Assessment of growth and pubertal development should be performed by the endocrinologist. Biological tests can contribute to the understanding of hormonal abnormalities that might influence disturbances of growth and puberty. A tight collaboration between the endocrinologist and the clinician in charge of the disease is needed to evaluate the severity of the disease and the modalities of its treatment. The availability of more efficient treatment may allow for reducing the impact of the chronic disease on growth. However, GH therapy treatment and/or sex steroid should be considered as adjunctive therapies in case of severe growth failure and pubertal delay.

In conclusion, chronically-ill children are at high risk of developing growth failure. They should be followed by endocrinologists early in the course of their disease to detect growth disturbances. The later the patient will be seen, the less advantageous will be the long-term benefits of hormonal therapies.