Slipped Capital Femoral Epiphysis Occurred in Patients over 20 Years - Two cases -

Slipped Capital Femoral Epiphysis Occurred in Patients over 20 Years - Two cases -

Sung-Taek Jung

Jin Choi

Bong-Hyun Bae

Yong-Uk Kim*

Sung-Man Rowe

Department of Orthopedics Chonnam National University Hospital,

Department of OrthopedicsGwangju City Hospital *

Case 1

• 30 year-old, male • C/C: Left hip pain & restriction of joint movement (minor trauma 7 days prior to visit)

• P/H: Surgical removal of pituitary gland at 17 year-old d/t craniopharyngioma Residual tumor resection at 22 year-old

Case 1

• Chronologic Age: 30 year-old

• Bone Age: 13 year-old

• Height: 157 cm

• Weight: 40 Kg

• Small genitalia

• No pubic & axillary hair

Case 1

• Radiographic findings (Preop)

Case 1

• Endocrinologic lab. findings

Hormone Patient Normal level

T3 63 ng/dl 80-220

Free T4 0.14 ng/dl 0.7-2

LH 0.21 mIU/ml 10-25

FSH 0.01 mIU/ml 10-30

Growth H <0.1 ng/ml 1-5

Testosterone <0.01 ng/ml 1.88-8.96

Cortisol <0.1 ug/dl 3-23

Prolactin 6.59 ng/ml 0-25

• Chromosomal study : 46, XY

T3; triiodothyronine, T4; thyroxine, LH; luteinizing hormone, FHS; follicular stimulating hormone

Case 1

• Radiographic findings (Postop)

Case 2

• 24 year-old, female • C/C: Left hip pain & restriction of joint movement ( slip down 3 weeks prior to visit)

• Chronologic Age: 24 year-old

• Bone Age: 12.6 year-old

• Height: 173 cm

• Weight: 55.8 Kg

• No closure of epiphyseal plates

• Brain MRI: Non-specific finding

Case 2

• P/H: Growth hormone therapy at 12 year-old d/t short stature

• Amenorrhea

• Breast: Tanner stage I

• No pubic & axillary hair

• Sonography: 2 cm sized uterus & no ovary

Case 2

Case 2

• Radiographic findings (Preop)

Case 2

• Endocrinologic lab. findings

Hormone Patient Normal level

T3 123 ng/dl 80-220

T4 5.6 ng/dl 4.5-12.5

LH 0.01 mIU/ml 10-25

FSH 0.30 mIU/ml 10-30

Estradiol 20 pg/ml 30-120

Growth H <0.1 ng/ml 1-5

Cortisol 0.1 ug/dl 3-23

Prolactin 11.15 ng/ml 0-25

• Chromosomal study : 46, XX

T3; triiodothyronine, T4; thyroxine, LH; luteinizing hormone, FHS; follicular stimulating hormone

Case 2

• Radiographic findings (Postop)

DiscussionDiscussion

- Zondek, 1936 - Rubinsten, 1939

- Ray et al, 1941 - Gardner et al, 1943

- Harris, 1950 - Chung, 1976

Endocrinopathy in SCFEEndocrinopathy in SCFE• Growth hormone (GH)

Proliferation of chondrocytes Accelerated development of epiphysis Weakened the support for the shear force

• Sex hormone (SH) Suppress the proliferation of chondrocytes Termination of growth of physeal plate

• Absolute increase of GH

• Absolute decrease of SH

• Relative reduction of SH

• Thickness of physeal plate

• Weakened binding of epiphysis to metaphysis

SCFE

• Hypothyroidism

• Hypogonadism

• Panhypopituitarism

• Growth hormone therapy

EndocrinologicEndocrinologic factorsfactors

Ratio of GH & SHRatio of GH & SHCase I Patient Normal Growth H <0.1 ng/ml 1-5

Testosterone <0.01 ng/ml 1.88-8.96

Ratio (G/S) 10/1 1/8.9 ~ 2.7/1

Case II Growth H <0.1 ng/ml 1-5

Estradiol 20 pg/ml 30 -120

Ratio (G/S) 5/1 8.3/1 ~ 166.7/1

Growth hormone therapy history (+)

SCFE in HypopituitarismSCFE in Hypopituitarism

• Preop. & Postop. Management Preop. & Postop. Management : Glucocorticoids should be administered

• Reported SCFE with hypopituitarism: Kim et al, 1988 Moorefield et al, 1976

• Proper management : Preop. & Postop. Glucocorticoids Prophylactic pinning

• Incidence of pituitary tumor: 1.6~1.8 / 100,000

Discussion PointsDiscussion Points

Be aware of Possibility of Be aware of Possibility of SCFE with hypopituitarism SCFE with hypopituitarism

Thank You for

Your Kind Attention !

Thank You for

Your Kind Attention !