A stupid question about growth (August 2001)

This doesn't really answer the question about growth spurts, but as far as whether or not or not there are other hormones which come into play with growth, the answer is most definitely "yes." Most of them are not even produced in the adrenal glands. My son's major issue with CAH is advanced bone age and growth.....so I've been trying to read up on this topic as much as I can, to figure out what is CAH related---and, therefore, can be controlled---and what is not. Some of the other hormones which influence growth: thyroxine; growth hormone; insulin; somatomedins; and human chorionic somatomammotropin. Don't ask me what they all are or what they do...for the most part, I haven't the faintest idea! The only point I'm trying to make is that what happens in the adrenal glands is just a part of the picture, and not---by any means---the whole picture.

With CAH, growth can be negatively affected in two ways---with giving too much steroid and with giving too little---that is why it is so important to walk that fine line between under- and over-suppression, during a child's formative years. Steroids interfere with the body's ability to secrete/utilize (terminology?) Growth Hormone. So, if you are consistently oversuppressed, you do not grow because the drugs you have to take to control the CAH interferes with the body's natural growth process.

Giving too little medication is also detrimental to growth because it makes your bone plates close prematurely and, once that happens, linear growth ceases completely. I believe it is the hormone estrogen, that is responsible for bone maturation. A small amount of estrogen is produced in the adrenal glands, but most of it is produced in the ovaries. However, a portion of the testosterone that is produced in the adrenal glands, in both boys and girls, is converted into estrogen. Since CAH is a condition that results in the overproduction of male sex hormones (otherwise known as androgens) of which testosterone is one, too much testosterone would, therefore, result in too much estrogen, which would result in advanced bone age. (Or, at least, that is my understanding of the situation.) So, in that way, undersuppression in CAH can also have a potential negative effect on growth.

During puberty, HUGE quantities of estrogen and testosterone start to be produced in the ovaries and testicles---much greater than the amounts produced in the adrenals---so the danger of premature bone fusion becomes that much greater. Since persistent undersuppression with CAH can trigger precocious puberty, avoiding undersuppression becomes that much more important, to ensure that that doesn't happen.

I think the goal with treating CAH is to promote normal rates of growth, that is, avoiding too much medication which would slow down growth. And avoiding, too little, which would speed it up. To that degree, (and to get back to Wendy-Lee's original other question) I would guess that a CAH child could still undergo normal growth spurts, even if well controlled, though I do not know for sure. It's just that it's so hard to tell what is too much and what is too little when you are dealing with a constantly moving and changing target. But that is also why it is so important to monitor our children's levels, during the growing years, to make sure neither is happening.