Psychosocial Short Stature Workup

Updated: Aug 09, 2018
  • Author: Andrew P Sirotnak, MD; Chief Editor: Caroly Pataki, MD  more...
  • Print
Workup

Laboratory Studies

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:

  • CBC count

  • Urinalysis

  • 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.

Next:

Imaging Studies

No routine radiology studies are needed. If review of history or physical examination is suggestive of skeletal trauma, appropriate radiographs should be obtained. [11] 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.

Previous
Next:

Other Tests

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.

Previous
Next:

Procedures

No routine procedures are necessary for diagnostic evaluation.

Previous