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The Aetiology of Growth Failure in Psychosocial Short Stature

Psychosocial short stature (PSS) is a characteristic syndrome of growth failure associated with an abusive environment, most commonly after occult sexual abuse. The clinical presentation is usually the conundrum of a short child with growth failure with a normal body mass index, and yet a voluminous appetite. PSS has the characteristic pathonogmonic features of partial and temporary reversible GH deficiency, contemporaneously with a dramatic improvement in growth rate upon a change to a more suitable environment. The most characteristic subtype of PSS is classified as type IIA which is also known as hyperphagic short stature. Hyperphagia is an important feature of hypothalamic dysfunction and predicts the reversibility of both GH deficiency and growth failure on a change in environment. The patient illustrated by Saitoh et al. (page 439 of this issue) has all the hallmarks of type IIA PSS: growth failure, GH insufficiency, absence of response to GH treatment, low birth weight, physical abuse, change in personality and hyperphagia. Moreover, there was a change in GH secretion and catch-up growth in association with a change in environment, as well as changes in serum IGF-I concentrations. As has been described in PSS, as well as in the patient by Saitoh et al., there is no change in body mass index in spite of hyperphagia. Indeed, it is the hyperphagia that is characteristic of type IIA PSS, which points to the recovery of GH secretion and