Psychosocial Short Stature Workup
- Author: Andrew P Sirotnak, MD; Chief Editor: Caroly Pataki, MD more...
Order baseline screening for FTT to exclude common organic causes of growth failure. In psychosocial short stature (PSS), results of these tests are within the reference ranges. Baseline screening for FTT includes the following:
Renal function screens (BUN, creatinine)
Stool for ova and parasites
Stool fat analysis
Sweat test (if cystic fibrosis is suspected)
A pediatric endocrinologist should evaluate the endocrine dysfunction observed in these patients. A heterogeneous pattern of abnormalities is observed in persons with type II PSS.
Fasting GH levels are less than the reference range in individuals with type II PSS, and fasting GH levels are within the reference range in persons with type I PSS and type III PSS. Arginine stimulation testing often fails to release GH in individuals with type II PSS. Administration of GH to patients with type II PSS produces minimal or no growth response and induces only a minimal rise in Sm-C or insulinlike growth factor-1 (IGF-1).
Sm-C and IGF-1 levels have been demonstrated to be low in the limited number of children with type II PSS who have been tested. These levels have been shown to normalize when the child is removed from the adverse environment. Sm-C and IGF-1 levels are within the reference range in persons with type III PSS.
Corticotrophin (ACTH) secretion measured by metyrapone testing can be abnormally low in persons with type II PSS. ACTH secretion eventually normalizes when the child is in a nurturing environment.
Thyroid function determined by iodine uptake can be outside of the reference range. Peripheral thyroxine (T4) levels are usually within the reference range in individuals with all types of PSS.
No routine radiology studies are needed. If review of history or physical examination is suggestive of skeletal trauma, appropriate radiographs should be obtained. If the mental status examination is markedly abnormal, obtain imaging studies of the brain exclude brain tumor, the most common solid tumor of childhood.
Severe abdominal distention or signs of bowel obstruction may prompt evaluation with abdominal plain film radiography or upper gastrointestinal (UGI) series. Bezoars from food gorging and nonspecific alterations of bowel motility have been reported.
Temporary widening of the cranial sutures has been reported and may be related to the rapid increase in brain growth during catch-up growth in height and weight.
Temporary growth arrest lines can be observed in metaphyses of the long bones.
EEG abnormalities have been reported in the early phase of type II PSS in hospitalized children with the condition.
Decreased slow-wave sleep (stages III and IV) has been demonstrated; however, this reverses to normal when the child is removed from the adverse environment.
No routine procedures are necessary for diagnostic evaluation.
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. 2008 Jun 2. 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. 2011 Oct. 96(10):E1606-11. [Medline].
Money J. The syndrome of abuse dwarfism (psychosocial dwarfism or reversible hyposomatotropism). Am J Dis Child. 1977 May. 131(5):508-13. [Medline].
Tarren-Sweeney M. Patterns of aberrant eating among pre-adolescent children in foster care. J Abnorm Child Psychol. 2006 Oct. 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). 1994 May. 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. 1994 Nov-Dec. 4(8):234-7. [Medline].
Sandberg DE, Colsman M. Assessment of Psychosocial aspects of short stature. Growth, Genetics and Hormones. June 2005. 21(2):[Full Text].
Gloebl HJ, Capitanio MA, Kirkpatrick JA. Radiographic findings in children with psychosocial dwarfism. Pediatr Radiol. 1976 Feb 13. 4(2):83-6. [Medline].
Blizzard RM, Bulatovic A. Syndromes of psychosocial short stature. Pediatric Endocrinology. 1996. 83-93.
Fazil Q. Dwarfism: Medical and psychosocial aspects of profound short stature. Psychiatr Bulletin. 2006. 30:[Full Text].
Green WH, Campbell M, David R. Psychosocial dwarfism: a critical review of the evidence. J Am Acad Child Psychiatry. 1984 Jan. 23(1):39-48. [Medline].
Inokuchi M, Hasegawa T. [Deprivation dwarfism]. Nippon Rinsho. 2006 May 28. Suppl 1:102-4. [Medline].
Lifshitz F, Tarim O, Smith MM. Nutritional growth retardation. Pediatric Endocrinology. 3rd ed. 1996. 103-20.
Northam EA. Neuropsychological and psychosocial correlates of endocrine and metabolic disorders--areview. J Pediatr Endocrinol Metab. 2004 Jan. 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. 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. 1994 Jan. 15(1):39, 41. [Medline].