What Causes Growth Hormone Deficiency in Children?
Growth hormone deficiency in children can result in short stature and stunted growth. Deficiency can result from an inherited isolated Growth hormone deficiency, developmental defects such as pituitary aplasia, pituitary hypoplasia, or even pathological etiologies such as a tumor of the hypothalamus or pituitary gland. In children with tumors of the head and neck such as craniopharyngioma or children who have undergone surgery/radiation therapy for other nasopharyngeal carcinomas may also present with HGH deficiency due to the destruction of the somatotroph cells in the pituitary gland. Occasionally, growth hormone deficiency may be a consequence of trauma, hemorrhage, and subsequent infarction of the hypothalamus or pituitary gland.
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Regardless of the cause, children diagnosed with short stature as a consequence of growth hormone deficiency often receive recombinant growth hormone replacement. In conditions that result from a true deficiency of growth hormone, replacement therapy can be highly beneficial for ensuring proper growth in physically stunted children.
Wrongful Diagnosis Of Growth Hormone Deficiency
Although rare, HGH deficiency can be wrongfully diagnosed in children presenting with a chief complaint of stunted growth. In fact, for these children who are misdiagnosed as having a growth hormone deficiency, hormone replacement can be helpful to a limited extent only. In such cases, the culprit behind the stunted growth could be emotional deprivation simulating a growth hormone deficiency.
Diagnosis of emotional deprivation in children can be difficult due to the vagueness of the presentation and is only diagnosed when children do not respond to traditional treatments that are successful in other growth hormone-deficient children.
Study on Emotional Deprivation’s role In Stunted Growth
A study examined two patients who presented with symptoms characteristic of isolated growth hormone deficiency and stunted growth. Both children presented with characteristics of severe growth hormone deficiency at the age of 5 years for which the two patients received treatment with growth hormone therapy for one year showing an increase in height of greater than or equal to 8 centimeters on average. With continued therapy in the third year, both children failed to demonstrate a significant increase in stature despite adequate and consistent growth hormone replacement therapy.
As the pediatricians observed the patients during the course of the treatment, they began to observe abnormalities in the behavior of their patients. The two children demonstrated disturbing signs of a dysfunctional family such as abnormal responses to social situations, eating disorders, and even problems with normal digestion.
Upon further investigation of the nature of the patient’s family condition, both were found to be in a dysfunctional environment for rearing children with parents suffering from alcoholism and low income. The patients were found to be subject to rejection from their family members, neglect, and unhealthy inadequate nourishment.
After the two children were removed from their dysfunctional environment to more stable accepting surroundings, they had a significant increase in growth hormone levels and thereby increase in stature. As the growth hormone deficiency was found to be no longer present and completely reversed, replacement therapy was terminated in both patients.
Adequate diet, exercise, sleep, and a healthy psychological status are all essential for normal growth hormone release in children as well as adults. Despite being a difficult condition to diagnose due to the absence of any strict guideline, a major identifying clue to the diagnosis is the spontaneous cessation of growth hormone deficiency after removal of the child from their current environment.