Chronic Bilateral Slipped Capital Femoral Epiphysis as an Unusual Presentation of Congenital Panhypopituitarism due to Pituitary Hypoplasia in a 17-Year-Old Female

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Abstract

We report an interesting case of a 17-year-old normal-statured female who was diagnosed with congenital panhypopituitarism due to pituitary hypoplasia at the presentation of bilateral slipped capital femoral epiphysis. We emphasized the importance of endocrinologic evaluation in patients with atypical slipped capital femoral epiphysis to prevent potential complication of adrenal crisis during surgery. This case also demonstrates growth without growth hormone which resulted in a delay in diagnosis of congenital hypopituitarism in this patient.

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Most cited references 12

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Slipped capital femoral epiphysis associated with endocrine disorders.

R T Loder, B Wittenberg, G DeSilva (1995)

We reviewed 85 patients with endocrine disorders and slipped capital femoral epiphysis (SCFE). The disorders were hypothyroidism (40%), growth hormone deficiency (25%), and others (35%). The average age at diagnosis of the disorder was 13.2 +/- 6.2 years and 15.3 +/- 5.3 years at diagnosis of the first SCFE. In 53 hips, the bone and chronologic age were both known: 11.6 +/- 3.0 years bone age, 16.5 +/- 6.5 years chronologic age, p 16 years. The hypothyroid patients usually had the endocrine diagnosis made at presentation of the first SCFE; the growth hormone-deficient children usually had the endocrine diagnosis made before that of the SCFE (p < 0.01). None of those in whom the diagnosis of the endocrine disorder occurred after the diagnosis of the SCFE was hypothyroid or growth hormone deficient. All hypothyroid patients developed the first SCFE before or during hormonal supplementation; 92% with growth hormone deficiency developed the SCFE during or after supplementation (p < 0.01). Because the prevalence of bilaterality was 61% (p < 0.01), prophylactic treatment of the opposite hip should be considered.

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The growth without growth hormone syndrome.

Mitchell E Geffner (1996)

The phenomenon of growth without GH has been recognized for over a quarter of a century in various physiologic or near-physiologic situations, including the fetal state and obesity, and in various obviously pathologic states, including postsurgical resection of suprasellar/hypothalamic tumors, most notably craniopharyngiomas, and in acromegaloidism. The mechanism or mechanisms responsible for this fascinating clinical syndrome are unknown. The available data implicate, at least in some of these subjects, a role for hypothalamic injury leading to obesity and insulin resistance which, in turn, leads to elevated circulating concentrations of insulin to which the body retains mitogenic sensitivity. Alternatively, in other subjects with this syndrome, evidence exists to support the presence of a circulating as yet incompletely characterized potent growth-promoting factor which appears in the serum. Further studies of this syndrome should help to enhance our knowledge of the mechanisms governing both normal and abnormal human growth.

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Review of slipped capital femoral epiphysis associated with endocrine disease.

D E Wells, S. King, T F Roe … (2015)

Review of type and bilaterality of 131 cases (40 bilateral) of slipped capital femoral epiphysis (SCFE) in patients with known endocrinopathies (hypothyroidism, panhypopituitarism, hypogonadism) from 1960 to 1990 showed an increased frequency of patients with endocrine disorders, primarily hypothyroidism (nine of 131 patients, 6.9%); three had bilateral slips; six developed bilateral slips in an average of 11.17 months. Delayed growth plate closure is common in SCFE. Because hypothyroidism can be easily overlooked, all patients with SCFE should be screened for hypothyroidism by measuring serum T4 and TSH (such screening is inexpensive (r = $60). Pituitary deficiency should be considered in children short for their age who have hypogonadism. Any child with a unilateral slip and one of these endocrine deficiencies has a high risk of subsequent bilateral involvement. Prophylactic pinning of the uninvolved hip is recommended because 100% of our patients eventually had bilateral slips.

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Author and article information

Journal

Journal ID (nlm-ta): Int J Pediatr Endocrinol

Journal ID (publisher-id): IJPE

Title: International Journal of Pediatric Endocrinology

Publisher: Hindawi Publishing Corporation

ISSN (Print): 1687-9848

ISSN (Electronic): 1687-9856

Publication date (Print): 2009

Publication date (Electronic): 11 January 2010

Volume: 2009

Electronic Location Identifier: 609131

Affiliations

¹Division of Endocrinology, Department of Pediatrics, The Ohio State University College of Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA

²Department of Orthopedics, The Ohio State University College of Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH 43205, USA

Author notes

*Sasigarn A. Bowden: bowdens@ 123456pediatrics.ohio-state.edu

Recommended by Roberto Lanes

Article

DOI: 10.1155/2009/609131

PMC ID: 2814228

PubMed ID: 20130813

SO-VID: 4db74c86-7976-482f-aef9-fd290511dd99

License:

This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

History

Date received : 17 July 2009

Date accepted : 13 October 2009

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