Psychosocial Short Stature Research Articles

Growth recovery lines in children: A comparison between psychosocial short stature and other pathological causes of short stature

BackgroundPsychosocial short stature (PSS) is a rare disorder associated with emotional deprivation. Growth recovery lines (GRLs), the radiodense bands in metaphyseal bones, are indicators of stress. ObjectiveTo evaluate the efficacy of using GRLs in the distal radius to identify PSS. Participants and settingThis retrospective cohort study included children 15–138 months of age with short stature whose hands and wrists were radiographed between 2011 and 2020 at Matsuyama Red Cross Hospital in Japan. MethodsPSS was determined if a child with short stature had been reported to be abused or neglected. Other pathological short statures were diagnosed per the established criteria. GRLs, height velocity before and after specific treatment, insulin-like growth factor 1, and the difference between chronological and skeletal age were assessed. ResultsThe PSS and other short stature groups comprised of 7 and 11 children, respectively. The body mass index of the PSS group was smaller than that of other short stature group (−1.15 standard deviation [SD] vs. 0.57 SD, P = 0.003). The PSS group had significantly more GRLs than the other group (5.3 vs. 0.5, P = 0.011). Height velocity before treatment in the PSS group was significantly lower (−5.46 SD vs. −1.86 SD, P = 0.005), with no significant differences in other variables. The specificity for PSS was >90% when children with short stature had at least three GRLs in both distal radii. ConclusionsAbuse or neglect should be considered in children with short stature having multiple GRLs in the distal radius.

Hyperphagic psychosocial short stature – a clinical review

Hyperphagic short stature (HSS) is a specific syndrome of growth failure in association with hyperphagia without a clear underlying aetiology, seen in association with a stressful environment. Environmental stressors at home are not always immediately evident however these children characteristically demonstrate reversal of growth impairment when nurtured away from their stressful environment. This review describes the clinical phenotype, underlying endocrine dysfunction and strategies for the management of this complex condition.

Growth hormone secretion and long-term growth data in children with psychosocial short stature treated by different changes in environment.

We assessed auxological and endocrine data of 65 children (32 girls) from 51 families with an average age of 6.6 years (range, 0.9 to 16.5 years, all but five prepubertal) with psychosocial short stature. Fifty-one patients had an assessment of growth hormone (GH) secretion. Thirty-four were subjected to repeated testing with the first test being performed when the child was still in the adverse environment and the next testing after the child was removed. Twenty-five out of those 34 were repeatedly tested during one uninterrupted hospital admission with limited parental access. Thirty patients had a definite, long-term change in their environment (13 were separated from their families) and were assessed concerning their auxological data. Of the 34 patients who had repeated endocrine testing, 11 (32%) showed reversible GH deficiency (GHD), nine (26%) increased their previously normal peak GH concentration, and six (18%) had apparently irreversible GHD. Patients who had a change in environment increased their mean height velocity SDS from -0.9 (SD 1.5) to +1.5 (2.3) (p < 0.0001). Accordingly, height SDS increased from -2.9 (SD 0.8) before to -2.6 (SD 0.8) after the change (p < 0.001). One of the diagnostic features of psychosocial short stature is reversible GH insufficiency, which usually normalises after the child is separated from the adverse environment. Catch-up growth is always found after a positive change in the environment, and may occur within the family. However, if a change in environment is not possible, GH therapy may be an option.

No evidence for complete catch-up in final height in psychosocial short stature

No evidence for complete catch-up in final height in psychosocial short stature

Final height in psychosocial short stature: is there complete catch‐up?

Aim: To determine whether children with psychosocial short stature attain their genetic height potential. Methods: We report on 18 children (10 girls, 8 boys) diagnosed by a multidisciplinary team as having psychosocial short stature. All the children had had some kind of change in their environment (9 were separated from their families), and increased their mean height velocity standard deviation score (SDS) from −0.7 (1.3) to +3.6 (4.8) (p &gt; 0.005) as well as their height SDS from −3.0 (0.3) to −2.6 (0.9) in the first year after the change. All the patients were post‐pubertal and had reached their near final height (mean age, 20.0 y; range, 16.0–23.3). Results: Only 3 out of 18 had a greater final height than the mid‐parental target height, 14 out of 18 had a near final height within the mid‐parental target range (95% tolerance limits of the mid‐parental height (±2 SD =±10 cm). Nevertheless, mean final height expressed in height SDS for the whole group was significantly shorter with −2.4 SDS compared with the mean of the mid‐parental target height of −1.5 SDS (p &gt; 0.001). Surprisingly, initial catch‐up growth did not correlate with final height attainment. Conclusion: The majority of patients will attain a stature within the range of mid‐parental target height, although towards the lower limit of this range.

Body mass index and segmental proportion in children with different subtypes of psychosocial short stature.

We describe change in height, segmental proportion and weight in 46 children (19 girls, 27 boys, all but four prepubertal) diagnosed by a multidisciplinary team as having psychosocial short stature (PSS) who had a change in their environment (31 were separated from their family). The classification of PSS has recently been modified to include appetite disturbance at presentation: hyperphagic (IIA), non-hyperphagic (IIB) and anorexic type (III). The 46 patients were subdivided into these three classifications and analysed separately concerning their auxology and change in body mass index before and after intervention. Although in all groups a significant improvement in height velocity SDS was seen after intervention, subtle differences in body proportions could be demonstrated. Proportional short stature was seen in both non-anorexic types of PSS (type IIA and type IIB) and did not change with intervention, whereas a significant change in body proportion was found in the anorexic type (type III). Body mass index at presentation was within normal limits and did not increase significantly in any of the three subgroups after intervention. the main diagnostic feature of psychosocial short stature is catch-up growth after change of environment which occurs in almost all patients. The classification on the basis of appetite disturbance was supported by our auxological data with specific differences in body proportions.

Metaphyseal growth arrest lines in psychosocial short stature

Metaphyseal growth arrest lines are seen in children who experience significant physical stress such as infection or malnutrition over a sufficient period of time. These lines have not been reported...

A new stress-related syndrome of growth failure and hyperphagia in children, associated with reversibility of growth-hormone insufficiency

Growth failure without organic aetiology but associated with behavioural disturbance and psychosocial stress has been termed psychosocial short stature. This condition is not a valid diagnostic entity, but encompasses failure to thrive, stunting secondary to chronic malnutrition, and idiopathic hypopituitarism. Some children show spontaneous catch-up growth when removed from the source of stress, without further treatment, but until now precise definition of this subgroup for the purpose of clinical identification has not been possible. Hospital-referred children with growth failure unrelated to organic pathology, who came from stressful homes, were compared with children of short-normal stature identified from an epidemiological survey (n = 31). Growth-hormone dynamics were studied in the hospital group by a combination of diurnal profiles and provocation tests. The tests were repeated after a hospital stay of 3 weeks away from familial stress. Standard behavioural measures were obtained from home and school. In a distinctive subgroup (n = 29), growth-hormone insufficiency was associated with characteristic behavioural features, especially hyperphagia and polydipsia, and a normal body-mass index. When the children were removed from their stressful home circumstances, growth-hormone insufficiency spontaneously resolved only in formerly hyperphagic subjects. 74% of the non-hyperphagic cases (n = 23) were anorexic, with a low body-mass index and normal growth-hormone responses to provocation tests. We present explicit behavioural and developmental criteria by which the novel syndrome of hyperphagic short stature may be recognised clinically. Such children have a capacity for spontaneous recovery of growth-hormone production on removal from or reduction of stress. Discriminant and predictive validity of the core symptoms are demonstrated. Preliminary familial studies indicate a possible genetic predisposition.

The Health of Children Adopted From Romania

To determine the medical condition of Romanian adoptees and the effects of the Romanian orphanage system on their health. Case series. The international adoption clinics at the University of Minnesota, Minneapolis, and the New England Medical Center, Tufts University, Boston, Mass. Sixty-five Romanian adoptees who were brought to the United States during a 12-month period beginning in October 1990. Incidence of hepatitis B, intestinal parasites, tuberculosis, syphilis, human immunodeficiency virus type 1, growth failure, and developmental delay. Although the adopted children were presumably chosen from the most vital and attractive adoptees, only 15% were judged to be physically healthy and developmentally normal. Fifty-three percent had serological evidence of past or present hepatitis B infection, and 20% of screened children tested positive for hepatitis B surface antigen. In children aged 7 months or older, the overall prevalence of chronic hepatitis B was 23%. Intestinal parasites were found in 33% of subjects, and 45% of infected children had two or more pathogens identified. All the children tested for human immunodeficiency virus type 1 were negative. Two patterns of growth failure were observed that resembled the two subtypes of psychosocial short stature that occur in association with prolonged psychological harassment or emotional deprivation. Infants' length, weight, head circumference, and weight-for-height were adversely affected by institutionalization. Older children's height was reduced. Only 10% of children older than 12 months were developmentally normal. Romanian adoptees are an extraordinarily high-risk pediatric group as a consequences of decades of government-sanctioned child neglect and abuse.

12 Psychosocial short stature: a syndrome with many variables

PSS is at least two syndromes of significant frequency, which often go unrecognized. It occurs in all socioeconomic groups. It is variable in its presentation and often masquerades in its subtle forms as other pathological causes of short stature such as GHD, CDGP, malabsorption and failure to thrive. It is an entity about which we understand little in respect to biochemical pathophysiology, and one which offers a challenge to both clinicians and basic scientists.

Effect of human growth hormone treatment for 1 to 7 years on growth of 100 children, with growth hormone deficiency, low birthweight, inherited smallness, Turner's syndrome, and other complaints.

(1) Human growth hormone (HGH) has been given for one whole year or longer to 100 patients, aged 1·5 to 19 years, participating in the Medical Research Council Clinical Trial of HGH. Each patient was measured 3-monthly for a control year before treatment, and the majority for a control year after the first treatment year. All measurements were made by one anthropometrist. Radiographic measurements of widths of bone, muscle, and fat in calf and upper arm were made. Methods and standards for assessing the significance of a given height acceleration are presented. (2) The characteristics at diagnosis are given of 35 patients with isolated GH deficiency or hyposomatotrophism (HS), 18 with craniopharyngiomas and other CNS lesions, 3 with multiple trophic hormone deficiency, 18 with low birthweight short stature, 4 with hereditary smallness and/or delay in growth, 4 with psychosocial short stature, 1 with high resting HGH and low somatomedin, 6 with Turner9s syndrome, and 11 with other diagnoses. (3) 29 of the 35 HS patients were boys and 13 had an abnormally small penis and ill-developed scrotum. Only 2 were sibs. Parents averaged 40th centile for height. 4 children developed growth-suppressing antibodies, and had to cease treatment. The mean standard deviation score (SDS) for height at diagnosis was -4·7, range -2·6 to -7·3. Bone age SDS averaged -3·2, range -0·8 to -5·7. Skinfold SDS averaged +0·91. Limb muscle width SDS averaged about -3·0. GH peak in insulin hypoglycaemia averaged 4·7 ± 0·7 μU/ml, range 1 to 13. (4) A category of partial growth hormone deficiency is defined as patients with GH peaks of 7-20 μU/ml inclusive and height velocity SDS in the year before treatment between -1 and -2. Total HS patients have GH peaks of 1 to 6 μU/ml inclusive and height velocity SDS of &lt; -2. Partial HS patients are accelerated by HGH and should be treated; but their average acceleration is below that of total HS patients. (5) There was a highly significant relation (r = -0·64) between blood GH peak level and pretreatment height velocity in the HS patients. (6) The LBW patients were 10 boys and 7 girls; all the boys had normal genitalia. The average height SDS at diagnosis was -3·7; parents9 height centile averaged 50th, bone age SDS -1·8, skinfold SDS -0·9. GH peaks were all above 30

Diagnostic and prognostic value of short-term metabolic response to human growth hormone in short stature.

Metabolic tests of the response to three days of administration of human growth hormone (HGH) have been done on 55 patients aged 6·2 to 20·3 years. 22 had `isolated9 growth hormone deficiency (or hyposomatotrophic short stature, HS), 16 CNS tumours or multiple hormone deficiencies, 6 short stature associated with low birthweight, 3 psychosocial short stature, 4 Turner9s syndrome, 1 hereditary short stature, and 3 uncertain diagnosis. Height was measured at 3-monthly intervals for a full year, then HGH was given for a full year and the difference in rate, that is the acceleration during the growth hormone year, was calculated. The height measurements were all done by one measurer in 45 of the patients. In the metabolic test there were 5 baseline days followed by 3 days of a single injection of 10 IU HGH, then 2 final days. The means for urinary nitrogen excretion, blood urea, and urinary calcium excretion were calculated for the 5 baseline days and for the last 2 HGH days plus the one subsequent day. The difference between the means is given as a percentage of baseline values. The children with isolated growth hormone (GH) deficiency had a greater decrease in nitrogen excretion (33±3%) than the low birthweight cases and small children (7±5%), but there was overlap between individuals in the isolated deficiency group (range 12 to 66%) and the rest (range -12% to 42%); 2 deficient children were below a dividing line of 20%, and 1 Turner9s syndrome and 3 psychosocial short stature children were above it. The tumour and multiple deficiency patients had an average fall of 40±3% and showed no overlap with the low birthweight group. Blood urea and calcium excretion gave a worse separation. Within the isolated deficiency and the tumour and multiple deficiency groups there was no relation between any metabolic parameter and the amount of growth acceleration in the first year of HGH treatment. In the HS, though not in the tumour patients, there was a correlation (-0·60) between the decrease in percentage nitrogen excretion and peak GH level on stimulation and between per cent decrease in urinary nitrogen excretion and per cent decrease in blood urea (0·76). We conclude that the differential diagnostic value of the short-term metabolic test is very limited now that we have tests of GH response; and that in cases of isolated GH or multiple pituitary hormone deficiency the result of the metabolic test does not predict at all the height acceleration obtained on HGH treatment.