Short Stature due to Psychological Stress

Source: Endocrinology Advisor

A 5.5-year-old girl presented to the clinic with short stature. Her father adopted her when she was 3.5 years old. However, the mother did not approve of her adoption, hence she was neglected.

A father brought her 5½-year-old girl to the clinic with complaints of short stature. Father revealed that he adopted her when she was 3.5 years old. She was a shy kid who preferred playing alone. She avoided playing with other kids. However, otherwise, she was a well-behaved child. Father accompanied the patient, but the mother did not. Father’s main concern was that she is neither gaining weight nor getting tall despite having a voracious appetite.

During the past 3 years, she had an increased appetite. She would crave food and subsequently steal food from her peers’ lunchboxes. Moreover, she had a habit of hoarding food and would get up at night to eat. As an example, the father told the doctors that she would eat a dozen bananas at a time.

Moreover, besides her appetite, another concern was that her foster mother was not in favour of adopting her, therefore, the girl felt neglected and unwanted.

On examination, she was a thin, lean girl weighing 10.5 kgs. Moreover, she was only 91.6 cm tall. In other words, she was below the 3rd percentile. Additionally, she had hypertrichosis. However, there were no other signs suggestive of malnutrition.

Serological investigations revealed normal CBC, liver and renal function tests, thyroid, and cortisol levels. However, her peak growth hormone (GH levels) on clonidine and insulin-induced hypoglycemia tests were low (3.47 ng/ml and 3.24 ng/ml, respectively).

Magnetic resonance imaging of the pituitary was normal.

Initially, before the detailed history outlined her hyperphagia, the doctors had suspected isolated growth hormone deficiency (GHD). Therefore, they had started on GH therapy for the next 3 months with close follow-ups. However, the GH therapy showed no positive response. Thus, this forced the doctors to think of an alternate diagnosis. Consequently, they dug deeper into the history.

With her history, the doctors strongly suspected Hyperphagic short stature (HSS), a variant of Psychosocial short stature (PSS).

short stature

A repeat GH stimulation test with clonidine after 14 days of hospital stay, i.e., away from the psychosocial stress of her house, showed normal peak GH levels. Therefore, the doctors referred her to a psychiatrist who confirmed this diagnosis of HSS.

The psychiatrist advised a change of environment. Moreover, her parents were also included in the counselling sessions along with the patient.

Reference: Jagtap VS, Sarathi V, Lila AR, et al. Hyperphagic short stature: A case report and review of literature. Indian J Endocrinol Metab. 2012;16(4):624-626. doi:10.4103/2230-8210.98026

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Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.


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