Abstract
We describe the growth of 65 children (32 girls, 33 boys) from 51 families with an average age of 6.6 years (range, 0.9 to 16.5 years, all but 5 prepubertal) diagnosed by a multidisciplinary team as having environmental growth failure.
27 of our patients had occult sexual or physical abuse (group A), in 15 such abuse was highly suspected (group B), but in 23 only emotional deprivation could be related to growth failure (group C).
51 (78%) patients had an endocrine assessment, of whom 34 (67%) had repeated testing (25 (49%) during one uninterrupted hospital admission). 14 (41%) showed reversible growth hormone deficiency, 9 (26%) increased their growth hormone peak level during one admission, 6 (18%) had growth hormone deficiency in repeated testing. In all patients from group A and B the repeated testing demonstrated a noticeable result. Following an insulin stimulation test, only 4 patients demonstrated a cortisol peak concentration of less than 450 nmol/l. The average weight gain during hospital admission was 274 g/week.
27 patients had a change in their environment (10 were separated from their family), all had an increase In their height velocity SDS (from −0.76 (SD 1.6) to +2.39 (SD 2.5)), and 19 (70%) showed catchup growth (change in height velocity >2).
15 patients were treated with growth hormone before the diagnosis of psycho-social dwarfism was appreciated, and 4 (26%) achieved catch-up growth. All 7 patients who had growth hormone treatment coincident with environmental change achieved catch-up growth.
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Thomas, B., Hamill, G., Skuse, D. et al. LONG-TERM GROWTH DATA AND GROWTH HORMONE SECRETION IN 65 PATIENTS WITH PSYCHO-SOCIAL DWARFISM. Pediatr Res 33 (Suppl 5), S55 (1993). https://doi.org/10.1203/00006450-199305001-00313
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DOI: https://doi.org/10.1203/00006450-199305001-00313