REVERSIBILITY OF PHYSIOLOGICAL GROWTH-HORMONE SECRETION IN CHILDREN WITH PSYCHOSOCIAL DWARFISM

OBJECTIVE Reversibility of GH insufficiency with a change of environme nt is characteristic of psychosocial dwarfism, and excludes an organic endocrinopathy. However, the change in GH pulsatility has not previou sly been described. We therefore wished to study spontaneous GH secret ion before and after change to a more favourable environment in 11 chi ldren with psychosocial deprivation and short stature in order to eval uate if separation from the families can modify their patterns of GH s ecretion. PATIENTS AND DESIGN We describe 11 prepubertal children (6 M and 5 F; 2.2-13.5 years of age) who had growth failure and psychosoci al deprivation. They were diagnosed by a multidisciplinary team as hav ing environmental growth failure after admission to hospital for 3 wee ks. Six of them were discovered to have been sexually abused. During t he uninterrupted hospital admission parental access was restricted. Th ree sets of 18-hour GH profiles were performed on each child, except o ne child who had only two, during the 3-week admission. MEASUREMENTS P ulse analysis of GH profiles was by Fourier transformation. RESULTS On the first day of admission spontaneous GH secretion demonstrated a sp ectrum of abnormalities in the pattern of basal values, pulse frequenc y and pulse amplitude. Such GH insufficiency showed reversibility duri ng the 3 weeks in hospital. Indeed, there was a significant increase i n GH secretion which was amplitude modulated without any significant m odification in pulse frequency. CONCLUSION Our data indicate that ther e is abnormal physiological GH secretion in children with psychosocial deprivation, which is associated with growth failure. Despite a patho logical situation, each child retained his own characteristic pattern of GH pulsatility. The pattern of reversibility of abnormal GH pulsati lity provides information for the mechanism of the control of GH secre tion.