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[Psychosocially stunted growth masked as growth hormone deficiency]
B Doeker1, Simić-Schleicher, B P Hauffa
1Vestische Kinderklinik Datteln, Universität Witten-Herdecke.
Insights
Emotional deprivation can cause short stature, mimicking growth hormone deficiency. Removing children from adverse environments led to catch-up growth, resolving the condition.
Area of Science:
- Pediatrics
- Child Psychology
- Endocrinology
Background:
- Short stature is a common pediatric concern.
- Emotional deprivation can present as growth retardation, mimicking endocrine disorders like growth hormone deficiency.
- Accurate diagnosis is challenging due to overlapping symptoms.
Observation:
- Two children with growth retardation due to emotional deprivation initially presented with severe growth hormone deficiency.
- Initial growth hormone therapy showed increased growth velocity, but response diminished over time.
- Behavioral abnormalities, social disturbances, and eating/digestion disorders became apparent.
Findings:
- Risk factors included parental alcoholism, low income, and child rejection.
- Removal from the detrimental environment resulted in a significant increase in growth velocity.
- Growth hormone deficiency resolved spontaneously after environmental change, allowing treatment termination.
Implications:
- Psychosocial factors are critical for normal growth in children and adolescents.
- Environmental interventions are key for treating growth disorders linked to emotional deprivation.
- Distinguishing emotional deprivation from organic growth disorders is crucial for appropriate management and prognosis.
Abstract:
Short stature is a common reason for presenting a child to the pediatrician. Emotional deprivation may cause short stature and may simulate growth hormone deficiency. Diagnosis of emotional deprivation as the cause of growth retardation is difficult and misdiagnosed frequently despite of suspicious clinical signs. We report on 2 patients with growth retardation because of emotional deprivation. At the age of 5 years both children had a severe growth hormone deficiency. They received therapy with growth hormone and showed an increase of growth velocity to > or = 8 cm in the first year of treatment. But in the third year of treatment both patients showed a diminished response to the growth hormone therapy. During the period of observation the features of emotional deprivation became obvious through the extreme behavioural abnormalities. Both children showed disturbances in their social behaviour, and striking disorders concerning eating and digestion. The families of these children had severe social problems; alcoholism, low income and rejection of the child were risk factors. Removal from the current environment led to a characteristic increase of the growth velocity. Growth hormone deficiency was spontaneously reversible, so that treatment with growth hormone was terminated. The social environment and the psychical prosperity are essential growth factors in childhood and adolescence. The common features and risk factors of emotional deprivation are described. Spontaneous catch-up growth after removal from the current environment distinguishes this form of short stature from the other organic growth disorders.