Department of Paediatric Endocrinology, Makarios Children's Hospital, Nicosia, Cyprus.
Division of Pediatric Endocrinology, Paedi Center for Specialized Pediatrics, Nicosia, Cyprus.
Horm Res Paediatr. 2023;96(1):25-33. doi: 10.1159/000521074. Epub 2021 Nov 23.
The infantile, childhood, and adolescent periods of growth and development also represent times of increased vulnerability to stressors. Growth velocity in each period is dependent on the interplay of genetic, environmental, dietary, socioeconomic, developmental, behavioral, nutritional, metabolic, biochemical, and hormonal factors. A stressor may impact growth directly through modulation of the growth hormone axis or indirectly through other factors. The adaptive response to stressors culminates in behavioral, physiological, and biochemical responses which together support survival and conservation of energy. The immediate response involves activation of the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis. The time-limited stress response is at once antigrowth, antireproductive, and catabolic with no lasting adverse consequences. However, chronic activation of the stress system and hypercortisolism have consequential negative impacts on growth, thyroid function, reproduction-puberty, and metabolism. High cortisol suppresses growth hormone-insulin-like growth factor 1, hypothalamic-pituitary-gonadal, and thyroid axes and has been reported to be responsible for an increase in visceral adiposity, a decrease in lean mass, suppression of osteoblastic activity with risk of osteoporosis, and induction of insulin resistance. Early-life adversities, emotional or physical, have been associated with long-term negative physical and mental health outcomes. Existing models of chronic stress corroborate that early-life adversities can affect growth and have consequences in other aspects of well-being throughout the lifespan. Targeted interventions to reduce stress during infancy, childhood, and adolescence can have far-reaching benefits to long-term health as well as attaining adequate growth. In this review, we describe the neuroendocrinology of the stress response, the factors influencing growth, and the impact of chronic stress on growth during critical periods of infancy, childhood, and puberty with particular reference to growth, thyroid, and gonadal axis.
婴幼儿、儿童和青少年时期的生长发育也代表着对压力源易感性增加的时期。每个时期的生长速度取决于遗传、环境、饮食、社会经济、发育、行为、营养、代谢、生化和激素等因素的相互作用。压力源可能通过调节生长激素轴直接影响生长，也可能通过其他因素间接影响生长。对压力源的适应反应最终导致行为、生理和生化反应，共同支持生存和能量保存。即时反应涉及交感神经系统和下丘脑-垂体-肾上腺轴的激活。有限时间的应激反应具有抗生长、抗生殖和分解代谢作用，没有持久的不良后果。然而，应激系统的慢性激活和皮质醇过多对生长、甲状腺功能、生殖-青春期和代谢有相应的负面影响。高皮质醇抑制生长激素-胰岛素样生长因子 1、下丘脑-垂体-性腺和甲状腺轴，并被报道导致内脏脂肪增加、瘦体重减少、成骨细胞活性抑制导致骨质疏松风险以及诱导胰岛素抵抗。情感或身体上的早期逆境与长期的身心健康不良后果有关。现有的慢性应激模型证实，早期逆境会影响生长，并在整个生命周期的其他方面对幸福感产生影响。在婴儿期、儿童期和青春期进行针对性的干预以减少压力，可以对长期健康以及实现充分生长产生深远的益处。在这篇综述中，我们描述了应激反应的神经内分泌学、影响生长的因素以及慢性应激对婴儿期、儿童期和青春期关键时期生长、甲状腺和性腺轴的影响。
