Dexamethasone-Induced Abnormalities in Growth and Bone Metabolism in Piglets Are Partially Attenuated by Growth Hormone with No Synergistic Effect of Insulin-Like Growth Factor-I

Dexamethasone (DEX) therapy improves pulmonary compliance in premature infants with chronic lung disease; however, normal growth and bone development are impaired. Because DEX may mediate its effects by altering the GH-IGF-I axis, we investigated whether adjunctive therapy with GH or GH + IGF-I during DEX therapy could attenuate these DEX-induced effects. Piglets were randomized to placebo, oral tapered DEX (0.5, 0.3, and 0.2 mg kg-1 d-1 over 14 d), DEX + GH (0.1 mg kg-1 d-1) or DEX + GH + IGF-I (0.1 mg kg-1 d-1). Final whole body weight and length were improved with GH or GH + IGF-I compared with the DEX alone group. Plasma GH and IGF-I were not influenced by DEX, but infusion of IGF-I resulted in higher (p < 0.05) plasma IGF-I compared with all other groups at d 15. DEX reduced (p < 0.05) circulating IGFBP-2 and IGFBP-3 and liver IGFBP-2 and IGFBP-4 mRNA expression compared with controls. Treatment with DEX alone resulted in lower (p < 0.05) plasma osteocalcin, urinary N-telopeptide, and whole body and femur bone mineral density compared with controls, whereas results with piglets receiving adjunctive GH or GH + IGF-I were similar to those of controls. Given adjunctively, GH alone appears to partially counter the abnormalities in growth and bone metabolism associated with DEX therapy; however, this improvement cannot be attributed to higher circulating IGF-I, because combined therapy did not further improve growth or bone homeostasis compared with DEX + GH treatment. Growth hormone therapy has the potential to stimulate growth in infants exposed to steroid treatment.