Slipped capital femoral epiphysis with coexisting pituitary tumor
Keywords:
Slipped Capital Femoral Epiphysis, endocrine dysfunctions, managementAbstract
Introduction:
Slipped Capital Femoral Epiphysis (SCFE) is well associated with an underlying endocrine pathology.
The clinical implication is multiplied: avoiding anesthesia complication in SCFE surgical treatment, assessing the need of prophylactic pinning at contralateral hip, and early detection of underlying disease. This case report will discuss the lessons learned from the management of endocrine-related SCFE with coexisting pituitary tumor, along with the long-term clinical
outcome.
Methods:
A 17-year-old male was diagnosed with unstable SCFE and underwent in situ pinning of the femoral head using
3 cannulated screws.
Results:
Hormonal examination showed hypogonadism, hyperprolactinemia, and growth hormone deficiency. Brain scan displayed macroadenoma of pituitary gland. Five years later, the patient reported overall satisfaction of the treatment.
Conclusion:
Clinical manifestation of delayed sexual maturation was the result of deficiency of the sex hormones and also related to the pathogenesis of SCFE. It is recommended to screen for endocrine disorders in SCFEs patients.
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References
Lehmann CL, Arons RR, Loder RT, Vitale MG. The
epidemiology of slipped capital femoral epiphysis: an
update. J Pediatr Orthop. 2006;26(3):286–90. DOI:
1097/01.bpo.0000217718.10728.70.
Loder RT, Skopelja EN. The Epidemiology and
Demographics of Slipped Capital Femoral Epiphysis.
ISRN Orthop. 2011;486512. DOI: 10.5402/2011/486512.
Salter RB. Disorders of Epiphyses and Epiphyseal Growth.
Textbook of Disorders and Injuries of the Musculoskeletal
System. 3rd Ed. 1999. Pennsylvania: Lippincott Williams
& Wilkin.
Bitersohl B, Hosalkar HS, Zilkens C, Krauspe R. Current
concepts in management of slipped capital femoral
epiphysis. Hip International. 2015;25(2):104-14. DOI:
5301/hipint.5000189.
Roaten J, Spence DD. Complications related to the
treatment of slipped capital femoral epiphysis. Orthop
Clin North Am. 2016;47(2):405-13. DOI: 10.1016/j.
ocl.2015.09.013.
Witbreuk M, van Kemenade FJ, van der Sluijs JA, Jansma EP, Rotteveel J, van Royen BJ. Slipped capital femoral
epiphysis and its association with endocrine, metabolic
and chronic diseases: a systematic review of the literature.
J Child Orthop. 2013;7:213–223. DOI: 10.1007/s11832-
-0493-8.
Burrow SR, Alman B, Wright JG. Short stature as a
screening test for endocrinopathy in slipped capital
femoral epiphysis. J Bone Joint Surg Br. 2001;83(2):263–
Papavasiliou KA, Kirkos JM, Kapetanos GA, Pournaras
J. Potential influence of hormones in the development of
slipped capital femoral epiphysis: a preliminary study.
Journal of Pediatric Orthopaedics B. 2007;16(1):1–5.
DOI: 10.1097/BPB.0b013e328010b73d.
Madhuri V, Arora SK, Dutt V. Slipped capital femoral
epiphysis associated with vitamin D deficiency A Series
of 15 Cases. Bone Joint J. 2013;95-B(6):851–4. DOI:
1302/0301-620X.95B6.30806.
Jingushi S, Suenaga E. Slipped capital femoral epiphysis:
etiology and treatment. J Orthop Sci. 2004;9(2):214–9.
DOI: 10.1007/s00776-003-0755-2.
Moyer J, Jacks L, Hunter JD, Chan G. Slipped capital
femoral epiphysis and associated hypothyroidism. A
review of the literature with two classic case examples. J
Pediatr Endocrinol Metab. 2016;29(4):1-7. DOI: 10.1515/
jpem-2015-0311.
Nourbakhsh A, Ahmed HA, McAuliffe TB, Garges KJ.
Case report: bilateral slipped capital femoral epiphyses
and hormone replacement. Clin Orthop Relat Res.
;466(3):743-8. DOI: 10.1007/s11999-007-0099-x.
Loder RT, Wittenberg B, DeSilva G. Slipped capital
femoral epiphysis associated with endocrine disorders. J
Pediatr Orthop.1995;15(3):349–56.
Wyatt D. Lessons from the National Cooperative Growth
Study. Eur J Endocrinol. 2004;151(Suppl 1):S55-9.
Bowden SA, Klingele KE. Chronic Bilateral Slipped
Capital Femoral Epiphysis as an Unusual Presentation of
Congenital Panhypopituitarism due to Pituitary Hypoplasia
in a 17-Year-Old Female. Int J Pediatr Endocrinol.
;609131:1-3. DOI:10.1155/2009/609131.
Hu MH, Jian YM, Te Hsueh Y, Lin WH, Yang RS.
Slipped capital femoral epiphysis in an adult with
panhypopituitarism. Orthopedics. 2011;34(3):222. DOI:
3928/01477447-20110124-27.
Song KS, Lim YW, Ok IY, Lee SW. Delayed-onset
of slipped capital femoral epiphysis. J Orthop Sci.
;20(1):78-86. DOI: 10.1007/s00776-014-0660-x.
Brady RL, Price A. Delayed-onset slipped capital femoral
epiphysis: case report of association with pituitary tumor.
Am J Orthop (Belle Mead NJ). 2010;39(3):137-40.
Loder RT, Hensinger RN. Slipped capital femoral
epiphysis associated with renal failure osteodystrophy. J
Pediatr Orthop. 1997;17(2):205-11.
Nixon JR, Douglas JF. Bilateral slipping of the upper
femoral epiphysis in endstage renal failure. J Bone Joint
Surg Br. 1980;62-B(1):18-21
Loder RT, Hensinger RN, Alburger PD, Aronsson DD,
Beaty JH, Roy DR, Stanton RP, Turker R. Slipped capital
femoral epiphysis associated with radiation therapy. J
Pediatr Orthop. 1998;18(5):630-6.
Perry DC, Metcalfe D, Costa ML, Staa TV. A nationwide
cohort study of slipped capital femoral epiphysis.
Arch Dis Child. 2017;102(2):1132-6. DOI: 10.1136/
archdischild-2016-312328.
Peck D. Slipped Capital Femoral Epiphysis: Diagnosis
and Management. Am Fam Physician. 2010;82(3):258-62.
Noguchi Y, Samaki T. Epidemiology and demographics of
slipped capital femoral epiphysis in Japan: a multicenter
study by the Japanese Paediatric Orthopaedic Association.
J Orthop Sci. 2002;7(6):610–7. DOI: 10.1007/
s007760200110.
Loder RT, Starnes T, Dikos G. Atypical and Typical
(Idiopathic) Slipped Capital Femoral Epiphysis
Reconfirmation of the Age-Weight Test and Description
of the Height and Age-Height Tests. J Bone Joint Surg
Am. 2006;88(7):1574-81. doi:10.2106/JBJS.E.00662
Kohl BA, Schwartz S. Surgery in the patient with endocrine
dysfunction. Med Clin North Am. 2009;93(5):1031–47.
DOI: 10.1016/j.mcna.2009.05.003.
Heatley FW, Greenwood RH, Boase DL. Slipping of
the upper femoral epiphyses in patients with intracranial
tumours causing hypopituitarism and chiasmal
compression. J Bone Joint Surg Br. 1976;58(2):169-75.
Clement ND, Vats A, Duckworth AD, Gaston MS, Murray
AW. Slipped capital femoral epiphysis: is it worth the
risk and cost not to offer prophylactic fixation of the
contralateral hip?. Bone Joint J. 2015;97-B(10):1428-34.
DOI: 10.1302/0301-620X.97B10.33931.
