A new stress-related syndrome of growth failure and hyperphagia in children, associated with reversibility of growth-hormone insufficiency
A new stress-related syndrome of growth failure and hyperphagia in children, associated with reversibility of growth-hormone insufficiency
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DOI：
10.1016/s0140-6736(96)01358-x
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发表时间：
1996-08-10
期刊：
影响因子：
168.9
通讯作者：
Voss, L
中科院分区：
文献类型：
--
作者：
Skuse, D;Albanese, A;Voss, L
背景：无器质性病因但与行为障碍和心理社会压力相关的生长衰竭被称为心理社会矮个子。这种情况不是一个有效的诊断实体，但包括发育不良、慢性营养不良继发发育迟缓和特发性垂体功能减退。一些儿童在没有进一步治疗的情况下，在远离压力源后表现出自发的追赶性生长，但直到现在，为了临床鉴定的目的，这一亚群的精确定义还不可能。方法将来自压力家庭的医院转诊的与器质性病理无关的生长衰竭儿童与来自流行病学调查的正常矮小儿童（n=31）进行比较。在医院组中，生长激素动态通过每日记录和刺激试验相结合进行研究，在远离家庭压力的住院3周后重复进行测试，从家庭和学校获得标准行为测量。在一个独特的亚组（n=29）中，生长激素不足与特征性行为特征，特别是贪食和烦渴，以及正常的体重指数相关。当孩子们离开他们紧张的家庭环境时，生长激素不足仅在以前的贪食者中自行解决，74%的非贪食病例（n=23）厌食，身体质量指数低，对刺激测试的生长激素反应正常。解释：我们提出明确的行为和发育标准，通过这种新的多食性身材矮小综合征可能在临床上被识别。这些儿童有能力在消除或减少压力后自发恢复生长激素的产生，证明了核心症状的判别和预测有效性。初步的家族性研究表明可能有遗传倾向。
Background Growth failure without organic aetiology but associated with behavioural disturbance and psychosocial stress has been termed psychosocial short stature, This condition is not a valid diagnostic entity, but encompasses failure to thrive, stunting secondary to chronic malnutrition, and idiopathic hypopituitarism. Some children show spontaneous catch-up growth when removed from the source of stress, without further treatment, but until now precise definition of this subgroup for the purpose of clinical identification has not been possible.Methods Hospital-referred children with growth failure unrelated to organic pathology, who came from stressful homes, were compared with children of short-normal stature identifed from an epidemiological survey (n=31). Growth-hormone dynamics were studied in the hospital group by a combination of diurnal profiles and provocation tests, The tests were repeated after a hospital stay of 3 weeks away from familial stress, Standard behavioural measures were obtained from home and school.Findings In a distinctive subgroup (n=29), growth-hormone insufficiency was associated with characteristic behavioural features, especially hyperphagia and polydipsia, and a normal body-mass index. When the children were removed from their stressful home circumstances, growth-hormone insufficiency spontaneously resolved only in formerly hyperphagic subjects, 74% of the non-hyperphagic cases (n=23) were anorexic, with a low body-mass index and normal growth-hormone responses to provocation tests.Interpretation We present explicit behavioural and developmental criteria by which the novel syndrome of hyperphagic short stature may be recognised clinically. Such children have a capacity for spontaneous recovery of growth-hormone production on removal from or reduction of stress, Discriminant and predictive validity of the core symptoms are demonstrated. Preliminary familial studies indicate a possible genetic predisposition.