A school-age child with congenital adrenal hyperplasia (CAH) is receiving long-term glucocorticoid therapy. At recent follow-up visits, the nurse notes the child's height and weight have consistently dropped compared with peers of the same age. Which interpretation is most accurate?

A. Growth suppression may indicate glucocorticoid dosing is too high: Excess glucocorticoids can impair linear growth by inhibiting bone formation and altering metabolism. A consistent drop in height and weight percentiles suggests overtreatment and requires dose reassessment. B. Fluctuations are expected and no intervention is needed: While mild changes may occur, a sustained downward trend in growth is not expected. It signals a problem that should be addressed rather than dismissed as normal variation. C. This is a typical growth pattern for children with congenital adrenal hyperplasia: Children with CAH can achieve normal growth with proper treatment. Declining growth percentiles are not typical if therapy is appropriately balanced. D. The decline indicates successful suppression of excess androgens: Effective androgen suppression should support more normal growth, not cause growth faltering. A downward growth trend instead reflects adverse effects from excessive glucocorticoid therapy.