Background
Psychosocial short stature (PSS) is a disorder of short stature or growth failure and/or delayed puberty of infancy, childhood, and adolescence that is observed in association with emotional deprivation, a pathologic psychosocial environment, or both. A disturbed relationship between child and caregiver is usually noted. A number of pediatric endocrinologists have studied and categorized several generally accepted subtypes; these clinicians also have described therapeutic interventions for children with PSS.
The following 3 subtypes are described, based on the patient's age at presentation and the clinical findings:
- In type I PSS, the age of onset is infancy. Usually, failure to thrive (FTT) is present, but no bizarre behaviors are observed. Patients are often depressed. Normal growth hormone (GH) secretion is found, but responsiveness to GH is unknown. No history of parental rejection is present in type I PSS.
- In type II PSS, the age of onset is 3 years or older. Some of these patients have FTT. Bizarre behaviors are usually observed, and patients are often depressed. Decreased or absent GH secretion is found with minimal responsiveness to GH. A history of parental rejection or pathology is present.
- In type III PSS, the age of onset is in infancy or older. FTT is not usually present, and bizarre behavior is not usually observed. GH secretion is normal; responsiveness to GH is significant. No history of parental rejection is present.
Pathophysiology
The pathophysiology of PSS is complex, involving some nutritional factors and a heterogenous endocrine dysfunction; however, the pathophysiology mostly involves psychological and environmental pathology, affecting the growth and development of the child. Endocrine disturbances of GH, secondary thyroid dysfunction, and somatomedin C (Sm-C) levels are reported in persons with type II PSS. Linear growth is obviously delayed. Growth arrest lines are observed in long bones, and temporary widening of cranial sutures has been reported. Sleep disturbance and pain agnosia are observed. Sequelae in higher cognitive and other psychological functions have been described in adults with a history of this disorder. Some recent neuroendocrine research has been focused on the relationship of environmental stress on growth.[1, 2]
Epidemiology
Frequency
United States
Frequency in the United States is unknown.
International
Worldwide frequency is unknown.
Mortality/Morbidity
Mortality rates are unknown. Because this is a form of severe child neglect, morbidity can be considered present in all children diagnosed with PSS. Therefore, the rate and severity of morbidity relates to the chronic nature of the deprivation, time of diagnosis, subsequent placement into a nurturing environment, and, finally, the long-term follow-up care while living in a secure and nurturing environment.
Race
All races are affected by child neglect; however, literature and early studies report that most cases of PSS occur in Caucasians.
Sex
Increased occurrence in males has been suggested only by anecdotal reports.
Age
The age of onset for type I PSS is infancy. The onset of type II PSS is in children aged 3 years or older. The onset in type III PSS occurs in infancy or later in childhood.
Deltondo J, Por I, Hu W, et al. Associations between the human growth hormone-releasing hormone- and neuropeptide-Y-immunoreactive systems in the human diencephalon: a possible morphological substrate of the impact of stress on growth. Neuroscience. Jun 2 2008;153(4):1146-52. [Medline].
Rotoli G, Grignol G, Hu W, Merchenthaler I, Dudas B. Catecholaminergic axonal varicosities appear to innervate growth hormone-releasing hormone-immunoreactive neurons in the human hypothalamus: the possible morphological substrate of the stress-suppressed growth. J Clin Endocrinol Metab. Oct 2011;96(10):E1606-11. [Medline].
Money J. The syndrome of abuse dwarfism (psychosocial dwarfism or reversible hyposomatotropism). Am J Dis Child. May 1977;131(5):508-13. [Medline].
Tarren-Sweeney M. Patterns of aberrant eating among pre-adolescent children in foster care. J Abnorm Child Psychol. Oct 2006;34(5):623-34. [Medline].
Duche DJ. [Consequences of family violence on children's health]. Bull Acad Natl Med. 2002;186(6):963-9; discussion 969-70. [Medline].
Albanese A, Hamill G, Jones J, et al. Reversibility of physiological growth hormone secretion in children with psychosocial dwarfism. Clin Endocrinol (Oxf). May 1994;40(5):687-92. [Medline].
Stanhope R, Wilks Z, Hamill G. Failure to grow: lack of food or lack of love?. Prof Care Mother Child. Nov-Dec 1994;4(8):234-7. [Medline].
Sandberg DE, Colsman M. Assessment of Psychosocial aspects of short stature. Growth, Genetics and Hormones [serial online]. June 2005;21(2):Accessed October 10, 2007. Available at http://www.gghjournal.com/volume21/2/featureArticle.cfm.
Gloebl HJ, Capitanio MA, Kirkpatrick JA. Radiographic findings in children with psychosocial dwarfism. Pediatr Radiol. Feb 13 1976;4(2):83-6. [Medline].
Blizzard RM, Bulatovic A. Syndromes of psychosocial short stature. In: Pediatric Endocrinology. 1996:83-93.
Fazil Q. Dwarfism: Medical and psychosocial aspects of profound short stature. Psychiatr Bulletin [serial online]. 2006;30:Accessed October 10, 2007. Available at http://pb.rcpsych.org/cgi/content/long/30/11/439.
Green WH, Campbell M, David R. Psychosocial dwarfism: a critical review of the evidence. J Am Acad Child Psychiatry. Jan 1984;23(1):39-48. [Medline].
Inokuchi M, Hasegawa T. [Deprivation dwarfism]. Nippon Rinsho. May 28 2006;Suppl 1:102-4. [Medline].
Lifshitz F, Tarim O, Smith MM. Nutritional growth retardation. In: Pediatric Endocrinology. 3rd ed. 1996:103-20.
Northam EA. Neuropsychological and psychosocial correlates of endocrine and metabolic disorders--areview. J Pediatr Endocrinol Metab. Jan 2004;17(1):5-15. [Medline].
Patton RG, Gardner LI. Short stature associated with maternal deprivation syndrome: disordered family environment as cause of so-called idiopathic hypopituitarism. In: Endocrine and Genetic Diseases of Childhood and Adolescence. 2nd ed. 1975:77-87.
Swanson H. Index of suspicion. Case 3. Diagnosis: failure to thrive due to psychosocial dwarfism. Pediatr Rev. Jan 1994;15(1):39, 41. [Medline].
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