Slipped upper femoral epiphysis and primary juvenile hypothyroidism

Slipped Capital Femoral Epiphysis Associated with Endocrinopathy: A Narrative Review

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Slipped capital femoral epiphysis (SCFE) has a well-documented association with underlying endocrine conditions, including thyroid hormone aberrations and parathyroid dysfunction.

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Recombinant growth hormone therapy has also been identified as a risk factor for the development of SCFE.

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Presentation before their 10th birthday or after their 16th birthday along with height of <10th percentile are reliable risk factors for identifying children with an SCFE who are at a heightened risk for an underlying endocrinopathy and can been used to guide selective laboratory testing.

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Patients with unilateral SCFE presentations with an underlying endocrinopathy are at a heightened risk for contralateral slip development and should be treated with prophylactic fixation.

Chronic slipping of bilateral distal humeral epiphyses in a gymnastist

In children, fracture-separation of the epiphyseal plate near the elbow joint is a common occurrence. However, separation of the distal humeral epiphysis is very rare, and in most cases, it is caused by high-impact trauma. In all reported cases, there has been a clear mechanism of injury. We report a case of an 11-year-old male patient who sustained separation of the distal humeral epiphyses bilaterally after 2 years of gymnastics, without a clear mechanism of injury. This patient had been using the vault since he was 9 years old, although children of that age do not normally perform on the vault. When gymnasts place their hands on the vault with their elbows flexed and subsequently extend their elbows to push off, the biomechanical load is placed equally on the right and left arms. Consequently, this type of repeated stress induces injury to the epiphyseal cartilages bilaterally, resulting in chronic progression of separation of the distal humeral epiphyses.

Slipped capital femoral epiphysis and hypothyroidism in a young adult: a case report

Introduction

Slipped capital femoral epiphysis is the most common hip disorder affecting the adolescent population, usually individuals between 8 and 15 years old. However, there are few case reports of older patients in the literature to date. It is believed that the etiology is multifactorial and may include obesity, trauma and, less frequently, endocrine pathologies comprising hypothyroidism, hypogonadism and panhypopituitarism.

Case presentation

We present the case of a 28-year-old Latino woman diagnosed with hypothyroidism secondary to arachnoidocele associated with skeletal immaturity and slipped capital femoral epiphysis.

Conclusions

It is important to conduct clinical and radiographic studies in these patients to rule out endocrine pathologies, especially hypothyroidism in those of sexual maturity.

Electronic supplementary material

The online version of this article (doi:10.1186/1752-1947-8-336) contains supplementary material, which is available to authorized users.

Osteopetrosis and congenital hypothyroidism complicated by slipped capital femoral epiphysis

OBJECTIVE

To describe a 13-year-old girl with unilateral slipped capital femoral epiphysis (SCFE), who presented with an acute onset limp during follow-up for congenital hypothyroidism and osteopetrosis.

METHODS

We present a case report detailing the patient's history as well as clinical, laboratory, and imaging findings and discuss the related literature.

RESULTS

The patient had been diagnosed elsewhere with congenital hypothyroidism, and levothyroxine therapy was initiated when she was 20 days of age; however, adherence to the treatment was irregular. Both her weight and her height were below the 5th percentile, her breast development and pubic hair were consistent with Tanner stage 1, and she had mental retardation and atypical facies. Her gait was antalgic; no muscle atrophy or shortness in the affected leg was present. On laboratory investigation, thyroid function tests were concordant with primary hypothyroidism. Her bone age was estimated as 8 years. Dual-energy x-ray absorptiometry revealed increased bone mineral density. Radiographic studies disclosed striking opacity of the bones of the pelvis and sclerosis at the skull base. Computed tomography of the affected left lower limb showed a fragmented appearance of the capital femoral epiphysis and thickening and irregularities of the physis line on the left, consistent with SCFE.

CONCLUSION

We underscore the possible facilitator role of osteopetrosis in the pathogenesis of SCFE, suggest the need to consider SCFE in the differential diagnosis when a lower extremity abnormality is detected in patients with congenital hypothyroidism or delayed puberty (or both), and emphasize this association with osteopetrosis.

Slipped upper femoral epiphysis in Hashimoto’s thyroiditis in a 29-year-old man

Slipped upper femoral epiphysis (SUFE) with an open physis is rare in an adult and the condition may present without prior diagnosis of an underlying medical condition. We have treated a 29-year-old man with bilateral SUFE associated with autoimmune hypothyroidism. The management was delayed and complicated by co-existing autoimmune chronic active hepatitis. He underwent thyroxine therapy and bilateral pinning in situ with a single ASNIS screw. Closure of the physis occurred after five months on the right side. The left side required a further corrective intertrochanteric osteotomy, and it was only after 13 months that complete fusion of this physis was seen. The case highlights the need to consider endocrine and metabolic conditions in atypical presentation of SUFE.

Potential influence of hormones in the development of slipped capital femoral epiphysis: a preliminary study

The potential influence of hormonal imbalance on the development of slipped capital femoral epiphysis was assessed through a prospective clinical study. The serum levels of T3, T4, thyroid-stimulating hormone, testosterone, estradiol, dehydroepiandrosterone-sulfate, follicle-stimulating hormone, luteinizing hormone, human growth hormone, adrenal cortex hormone and cortisol were evaluated in seven boys and seven girls. Forty-three out of 154 hormonal determinations (27.9%) were abnormal. The results showed increased incidence of pathological values mainly in the levels of follicle-stimulating-hormone, luteinizing-hormone and testosterone. No patient had clinical findings of endocrinopathy. A (possibly) temporary hormonal disorder may play a potentially significant role in the development of slipped capital femoral epiphysis.

Effects of TGF-beta1 and triiodothyronine on cartilage maturation: in vitro analysis using long-term high-density micromass cultures of chick embryonic limb mesenchymal cells

Endochondral ossification is initiated by differentiation of mesenchymal cells into chondrocytes, which produce a cartilaginous matrix, proliferate, mature, and undergo hypertrophy, followed by matrix calcification, and substitution of cartilage by bone. A number of hormones and growth factors have been implicated in this process. Using in vitro, long-term, high-density, micromass cultures of chick embryonic mesenchyme, that recapitulate the process of chondrogenesis, chondrocyte maturation, and hypertrophy, we have investigated the importance of a balance between proliferation and apoptosis in cartilage maturation, focusing specifically on the effects of transforming growth factor-beta1 (TGF-beta1) and the thyroid hormone, triiodothyronine (T3). Our results showed that TGF-beta1 stimulates proliferation, by week 2 of culture, and T3 inhibits proliferation by week 3. Cell size increases in cultures treated with T3. Collagen type X is expressed in all culture, and delay in matrix deposition is seen only in the cultures treated with TGF-beta1. T3 stimulates alkaline phosphatase activity, but not calcification. T3 enhances apoptosis, as seen by TUNEL staining, and internucleosomal DNA fragmentation. The results support the roles of T3 and TGF-beta in cartilage maturation, i.e., TGF-beta stimulates proliferation and suppresses hypertrophy, while T3 stimulates hypertrophy and apoptosis.

Slipped capital femoral epiphysis in patients with Down syndrome

The authors report their experience with eight patients (11 hips) with Down syndrome who sustained a slipped capital femoral epiphysis (SCFE). Six patients were diagnosed with hypothyroidism. All patients were greater than the 85th percentile for body mass index. Initial treatment was by in situ pinning in all hips. Six of the 11 slips progressed, 2 had collapse consistent with avascular necrosis, and 1 developed collapse secondary to joint sepsis and osteomyelitis. Additional surgery was necessary on seven hips. Four of eight hips followed until maturity had substantial femoral head deformity. Three of these patients had a noticeable limp and pain. Treatment of SCFE in patients with Down syndrome is difficult and the prognosis is guarded. These patients should be screened for hypothyroidism.

The adolescent with slipped capital femoral epiphysis

Slipped capital femoral epiphysis (SCFE) is an orthopedic disorder that occurs primarily in individuals in their early teen years. The disorder is one that requires immediate hospitalization for treatment purposes. This article discusses the symptoms of the disorder and the various treatments that are available for preventing future disability for the early adolescent. Because the adolescent has special needs and a long recovery period, nursing interventions must not only help in the resolution of the immediate orthopedic problems, but also be directed toward promotion of normal adolescent growth and development.

Musculoskeletal abnormalities in a patient with juvenile hypothyroidism

Abnormalities in growth and development are the most striking clinical features of juvenile acquired hypothyroidism. Therefore, physicians should consider the diagnosis of hypothyroidism in any child with musculoskeletal growth dysfunction. Drs Kilpatrick and Fincher describe a case demonstrating the severe and potentially irreversible effects of prolonged, untreated hypothyroidism.

Growth of children with physiolysis of the hip

Growth during adolescence was analyzed in 40 children with slipped capital femoral epiphysis using the Infancy Childhood Puberty growth model. The advantage of this model is that reference values for height can be adjusted for the individual age at pubertal maturation. In both sexes an above average height was found before the onset of the pubertal growth spurt. However, the pubertal gain in height was less than normal, and at maturity the heights were only slightly above the reference mean values. Most of the children had their first hip symptoms during the period of increasing gain in height at the initial stage of the pubertal growth spurt. Both boys and girls were overweight before puberty and remained so during puberty and at maturity.

Slipped capital femoral epiphysis in southern Sweden 1910-1982

This work is based on 532 cases of physiolysis colli femoris (PCF) in southern Sweden from 1910 through 1982. The material was analyzed epidemiologically. Subsets were used for different investigations aimed at surveying the etiology of PCF, and long-term follow-ups were conducted after various methods of treatment. Finally, the short-term results after hook-pinning, a new device, were evaluated. After radiographic examination of anatomic specimens and normal hips, a method to diagnose and grade PCF was developed. The calcar femoral was found to be of constant shape and position and was used as a landmark to which the position of the femoral head was related. The advantage of this method is that it is easy to use and it is able to determine PCF also after growthplate closure. Epidemiologic analysis of the total material revealed large changes during the 20th century. The disease is more common in males than in females, but the male predominance has decreased from about 90 per cent to about 60 per cent during the period of investigation. Mean age at onset of slipping has decreased by about 3 years in males to 12.7 years and by about 1 year in females to 11.8 years. The incidence has followed a periodic pattern with peaks approximately every 20th year. The mean incidence was 6/10,000 in boys and 3/10,000 in girls. Boys living in the country have always been at higher risk than those living in cities. They were also at higher risk of sustaining bilateral slipping. In girls, there is a seasonal variation, with a higher incidence between May and August. The etiologic investigations dealt with hereditary, mechanical, and hormonal aspects. Radiographic examination revealed PCF in about 10 per cent of the first-degree relatives of 50 consecutive patients with PCF. One third of the families had 2 or more members with PCF. This familial accumulation is much higher than shown in earlier investigations based on questionnaires or clinical reports, and higher than expected from the incidence calculations. The growth analysis using the ICP model showed in both sexes an above average body height before puberty. However, at maturity the heights were almost normal, and accordingly the pubertal gain in height was lower than normal. Both the boys and the girls were markedly overweight before puberty and remained so at maturity. The ICP model accords with what is known about hormonal regulation of growth, and the growth abnormalities indicate a disturbed hormonal growth regulation.(ABSTRACT TRUNCATED AT 400 WORDS)

Slipped capital femoral epiphysis in three generations

A male, his son, and grandson all had a slipped capital femoral epiphysis (physiolysis colli femoris--PCF). The importance of inheritance in PCF is discussed.