Growth and the Growth Hormone-Insulin Like Growth Factor 1 Axis in Children With Chronic Inflammation: Current Evidence, Gaps in Knowledge, and Future Directions

Endocr Rev. 2016 Feb;37(1):62-110. doi: 10.1210/er.2015-1026. Epub 2015 Dec 31.


Growth failure is frequently encountered in children with chronic inflammatory conditions like juvenile idiopathic arthritis, inflammatory bowel disease, and cystic fibrosis. Delayed puberty and attenuated pubertal growth spurt are often seen during adolescence. The underlying inflammatory state mediated by proinflammatory cytokines, prolonged use of glucocorticoid, and suboptimal nutrition contribute to growth failure and pubertal abnormalities. These factors can impair growth by their effects on the GH-IGF axis and also directly at the level of the growth plate via alterations in chondrogenesis and local growth factor signaling. Recent studies on the impact of cytokines and glucocorticoid on the growth plate further advanced our understanding of growth failure in chronic disease and provided a biological rationale of growth promotion. Targeting cytokines using biological therapy may lead to improvement of growth in some of these children, but approximately one-third continue to grow slowly. There is increasing evidence that the use of relatively high-dose recombinant human GH may lead to partial catch-up growth in chronic inflammatory conditions, although long-term follow-up data are currently limited. In this review, we comprehensively review the growth abnormalities in children with juvenile idiopathic arthritis, inflammatory bowel disease, and cystic fibrosis, systemic abnormalities of the GH-IGF axis, and growth plate perturbations. We also systematically reviewed all the current published studies of recombinant human GH in these conditions and discussed the role of recombinant human IGF-1.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Animals
  • Arthritis, Juvenile / immunology
  • Arthritis, Juvenile / pathology
  • Arthritis, Juvenile / physiopathology
  • Arthritis, Juvenile / therapy*
  • Child
  • Combined Modality Therapy
  • Cystic Fibrosis / immunology
  • Cystic Fibrosis / pathology
  • Cystic Fibrosis / physiopathology
  • Cystic Fibrosis / therapy*
  • Drug Therapy, Combination
  • Evidence-Based Medicine*
  • Growth Disorders / etiology
  • Growth Disorders / immunology
  • Growth Disorders / pathology
  • Growth Disorders / prevention & control*
  • Growth Plate / drug effects
  • Growth Plate / immunology
  • Growth Plate / metabolism
  • Growth Plate / pathology
  • Growth Substances / genetics
  • Growth Substances / metabolism
  • Growth Substances / therapeutic use
  • Human Growth Hormone / genetics
  • Human Growth Hormone / metabolism
  • Human Growth Hormone / therapeutic use
  • Humans
  • Inflammatory Bowel Diseases / immunology
  • Inflammatory Bowel Diseases / pathology
  • Inflammatory Bowel Diseases / physiopathology
  • Inflammatory Bowel Diseases / therapy*
  • Insulin-Like Growth Factor I / genetics
  • Insulin-Like Growth Factor I / metabolism
  • Insulin-Like Growth Factor I / therapeutic use
  • Practice Guidelines as Topic*
  • Puberty, Delayed / etiology
  • Puberty, Delayed / immunology
  • Puberty, Delayed / pathology
  • Puberty, Delayed / prevention & control*
  • Recombinant Proteins / metabolism
  • Recombinant Proteins / therapeutic use


  • Growth Substances
  • IGF1 protein, human
  • Recombinant Proteins
  • Human Growth Hormone
  • Insulin-Like Growth Factor I