Endocrine regulation of longitudinal bone growth.

Longitudinal growth is primarily influenced by the GH-IGF-I axis, which is a mixed endocrine-paracrine-autocrine system. Further, classical hormones such as thyroxine, glucocorticosteroids and sex steroids play a role, as well as primarily paracrine systems. In the GH-IGF-I axis, seven disorders can be differentiated: (1) GH deficiency; (2) GHR defects; (3) defects in the GH signal transduction pathway; (4) IGF1 defects; (5) IGFALS defects; (6) IGF1R defects, and (7) IGF2 defects. Children with one of the first 3 disorders have near-normal prenatal growth, while children with defects of IGF1, IGF1R or IGF2 show prenatal as well as postnatal growth retardation. Hypothyroidism or a thyroid hormone resistance cause growth failure, but the effect of hyperthyroidism on growth is modest. Hypercortisolism causes poor growth, while FGD caused by ACTH insensitivity is associated with tall stature. Increased sex steroids in childhood cause advanced growth but even more skeletal maturation, so that adult height is decreased. Finally, the paracrine-autocrine SHOX-BNP pathway and the related CNP-NPR2 pathway are also involved in growth, as very many other growth factors and their receptors and mediators.