Figure 1: Potential mechanisms of growth failure in children with IBD. An increase in inflammatory cytokines results in anorexia, undernutrition and subsequent delayed puberty. Inflammatory cytokines also induce down regulation of GH receptor expression in hepatocytes thus inhibiting post-receptor STAT5b activation and IGF-1 transcription. They also directly inhibit proliferation of growth plate chondrocytes. Corticosteroid exposure suppresses osteoblastogenesis, attenuates GH pulsatile secretion and inhibits GH receptor transcription.