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Reversible growth failure among Hispanic children: instances of psychosocial short stature
F Nieves-Rivera1, L González de Pijem, B Mirabal
1Pediatric Endocrinology Service, University of Puerto Rico School of Medicine, San Juan, Puerto Rico.
Insights
Psychosocial short stature (PSS) in children can be reversed with environmental changes. Early diagnosis and relocation led to catch-up growth and normalized growth hormone levels in three Puerto Rican boys.
Area of Science:
- Pediatric Endocrinology
- Child Psychology
- Growth Disorders
Background:
- Psychosocial short stature (PSS) is a reversible growth hormone deficiency (GHD)-like state.
- It is characterized by impaired growth due to psychological stress and neglect.
- Early identification and intervention are crucial for recovery.
Observation:
- Three Puerto Rican boys aged 4.5 to 15.5 years presented with poor growth and behavioral issues.
- Medical evaluations excluded organic causes for growth failure.
- Psychosocial assessments revealed histories of psychological abuse and bizarre behaviors.
Findings:
- Following relocation to nurturing foster environments, the children exhibited significant catch-up growth and weight gain.
- Biochemical markers, including insulin-like growth factor 1 (IGF-1) and growth hormone (GH) secretion, normalized.
- Improved social behavior was observed concurrently with physical and biochemical recovery.
Implications:
- This case series highlights the importance of suspecting PSS in children with unexplained growth failure.
- Prompt removal from abusive environments and placement in supportive settings are critical for successful outcomes.
- Recognizing PSS can prevent long-term consequences of GHD-like states.
Objective:
Psychosocial short stature (PSS), is the only known variant of reversible growth hormone deficiency (GHD)-like state. Herein we present three cases of Puerto Rican children with PSS, which will aid the uninitiated to the entity and assist in making the appropriate diagnosis. All of them demonstrated catch up growth and reversible GHD state as determined by increased insulin-like growth factor 1 (IGF-1) production and growth hormone secretion after pharmacologic stimulation.
Methods:
Three boys ages 4.5 to 15.5 years were evaluated because of poor growth at the University Pediatric Hospital in San Juan, Puerto Rico. Medical evaluation excluded organic causes for growth failure. Psychosocial evaluation revealed the presence of repeated instances of psychological abuse by caretakers and the subjects demonstrated patterns of bizarre behavior. These findings prompted evaluation toward the possibility of PSS. The three children were removed from their caretakers' homes and placed in foster nurturing environments.
Results:
Once relocated, the three children were able to demonstrate marked weight gain, growth acceleration, and improved social behavior. These changes were accompanied by biochemical evidence of GH-axis recovery as determined by the augmented insulin-like growth factor 1 levels and GH secretion. They have continued thriving at their foster homes. These results were felt to be compatible with PSS Type 2.
Conclusion:
We conclude that infants and children with growth failure without apparent organic cause, should be suspected of having PSS. Early relocation is critical for a successful outcome.