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The effect of acute and chronic stress on growth
1Department of Women's and Children's Health, Karolinska Institutet, Stockholm SE-17176, Sweden. lars.savendahl@ki.se
Insights
Stress impairs bone growth in children by affecting the growth plate via inflammation and cortisol. Treatments like immunomodulatory therapy and growth hormone (GH) show promise but require further study for optimal outcomes.
Area of Science:
- Pediatric endocrinology
- Inflammation and bone biology
- Growth disorders
Background:
- Stress in children can lead to impaired bone growth, with the growth plate being a key target.
- Mechanisms include elevated proinflammatory cytokines, cortisol, and disrupted growth hormone (GH)-insulin-like growth factor-1 (IGF-1) axis.
- Glucocorticoids and cytokines negatively impact chondrogenesis, with local IGF-1 offering partial amelioration.
Purpose of the Study:
- To investigate the impact of stress on bone growth in children.
- To evaluate the effectiveness of current and potential therapeutic strategies for stress-related growth impairment.
- To explore novel treatments for children unresponsive to conventional therapies.
Main Methods:
- Review of mechanisms by which stress affects the growth plate, including hormonal and inflammatory pathways.
- Analysis of the role of glucocorticoids, proinflammatory cytokines, and the GH-IGF-1 axis in chondrogenesis.
- Examination of therapeutic interventions such as glucocorticoid use, immunomodulatory agents (anti-TNFα), and GH therapy in conditions like juvenile idiopathic arthritis (JIA).
Main Results:
- Glucocorticoids and proinflammatory cytokines impair chondrogenesis, but local IGF-1 can partially improve these effects.
- Disease control and judicious glucocorticoid use are crucial for managing stress-impaired growth in chronic inflammation.
- Anti-TNFα therapy partially restores linear growth in some JIA patients; GH intervention may benefit some non-responders.
Conclusions:
- While current therapies like immunomodulatory agents and GH show potential, they do not completely normalize growth in all cases.
- Further research is needed to understand if GH can rescue growth in patients unresponsive to anticytokine therapy.
- Exploring new treatment strategies is essential for improving bone growth in children with stress-related growth impairment who do not respond to conventional treatments.
Abstract:
Impaired bone growth is observed in many children exposed to stress, but whether the underlying cause is psychological or secondary to a variety of chronic disorders is unclear. The growth plate is specifically targeted by stress through many different mechanisms, including increased serum concentrations of proinflammatory cytokines and cortisol, as well as impaired actions of the growth hormone (GH)-insulin-like growth factor-1 (IGF-1) axis. Both glucocorticoids, such as cortisol, and proinflammatory cytokines adversely affect several aspects of chondrogenesis in the growth plate, and these effects can be ameliorated by raising local IGF-1 concentrations. However, this intervention does not completely normalize growth. In children with stress related to chronic inflammation, the cornerstone of improving stress-impaired growth remains the judicious use of glucocorticoids while ensuring effective control of the disease process. Specific immunomodulatory therapy that targets the actions of tumor necrosis factor-α (TNFα) is at least partially effective at rescuing linear growth in many children with juvenile idiopathic arthritis (JIA). Patients who do not respond to anti-TNF treatment may be candidates for therapeutic agents that target other proinflammatory cytokines and for GH intervention. Although GH treatment rescues linear growth in some patients with JIA, it is unknown whether GH can rescue growth in those patients who do not respond to anticytokine therapy. Further experimental and clinical studies are needed to explore these and other new potential treatment strategies that could improve bone growth in patients who do not respond to conventional therapy.
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