Impaired bone growth is observed in many children exposed to stress, but whether the underlying cause is psychological or secondary to a variety of chronic disorders has been unclear. Bone growth may be affected by stress through different mechanisms, including increased levels of proinflammatory cytokines and cortisol, as well as impaired actions of the growth hormone–insulin-like growth factor–IGF-1 axis.
Both glucocorticoids and proinflammatory cytokines adversely affect several aspects of chondrogenesis in the growth plate, and these effects can be ameliorated by raising local IGF-1 concentrations. However, this intervention does not completely normalize growth. In children with stress related to chronic inflammation, improving stress-impaired growth tends to focus on use of glucocorticoids while ensuring effective control of the disease process.
Specific immunomodulatory therapies that target the actions of tumor necrosis factor–α are at least partially effective at rescuing linear growth in many children with juvenile idiopathic arthritis. Patients who do not respond to anti-TNF treatment may be candidates for therapeutic agents that target other proinflammatory cytokines and for growth hormone intervention. It is unknown whether growth hormone can rescue growth in those patients who do not respond to anticytokine therapy. Further experimental and clinical studies are needed in this area.
Presented at the European Society for Paediatric Endocrinology (ESPE) New Inroads to Child Health (NICHe) Conference on Stress Response and Child Health in Heraklion, Crete, Greece, 18 to 20 May 2012.
Sävendahl L: The Effect of Acute and Chronic Stress on Growth. Sci. Signal.Vol.5, Issue 247, pt9 (2012); [DOI: 10.1126/scisignal.2003484].