RESUMO
OBJECTIVE: Psychosocial short stature (PSS), is the only known variant of reversible growth hormone deficiency (GHD)-like state. Herein we present three cases of Puerto Rican children with PSS, which will aid the uninitiated to the entity and assist in making the appropriate diagnosis. All of them demonstrated catch up growth and reversible GHD state as determined by increased insulin-like growth factor 1 (IGF-1) production and growth hormone secretion after pharmacologic stimulation. METHODS: Three boys ages 4.5 to 15.5 years were evaluated because of poor growth at the University Pediatric Hospital in San Juan, Puerto Rico. Medical evaluation excluded organic causes for growth failure. Psychosocial evaluation revealed the presence of repeated instances of psychological abuse by caretakers and the subjects demonstrated patterns of bizarre behavior. These findings prompted evaluation toward the possibility of PSS. The three children were removed from their caretakers' homes and placed in foster nurturing environments. RESULTS: Once relocated, the three children were able to demonstrate marked weight gain, growth acceleration, and improved social behavior. These changes were accompanied by biochemical evidence of GH-axis recovery as determined by the augmented insulin-like growth factor 1 levels and GH secretion. They have continued thriving at their foster homes. These results were felt to be compatible with PSS Type 2. CONCLUSION: We conclude that infants and children with growth failure without apparent organic cause, should be suspected of having PSS. Early relocation is critical for a successful outcome.
Assuntos
Humanos , Masculino , Pré-Escolar , Criança , Adolescente , Hormônio do Crescimento/deficiência , Insuficiência de Crescimento/etiologia , Carência Psicossocial , Estatura , Peso Corporal , Crescimento , Hormônio do Crescimento/sangue , Hormônio do Crescimento/metabolismo , Insuficiência de Crescimento/sangue , Insuficiência de Crescimento/terapia , Fator de Crescimento Insulin-Like I/análise , Aumento de PesoRESUMO
El niño abusado puede manifestar deficiencias en su desarrollo congnoscitivo como consecuencia del maltrato. En este estudio, 22 niños con diagnóstico confirmado de maltrato físico y/o negligencia fueron evaluados con la Escala Mental de las Escalas Bayley de Desarrollo Infantil y reevaluados posteriormente. La edad promedio de los niños en la fase inicial fue de 8.4 meses. El índice de desarrollo mental (MDI) inicial promedio fue de 98.6 ñ 22.8. La reevaluación se hizo en un tiempo promedio de 10.8 meses. El MDI de la reevaluación fue 97.9 ñ 23.8. Los resultados no evidenciaron deficiencias cognoscitivas significativas en esta población. Concluimos que la detección e intervención temprana en el niño abusado favorece un desarrollo cognoscitivo adecuado