Acquired hypothyroidism and slipped capital femoral epiphysis. Report of three cases

Moorefield, W G; Urbaniak, J. R.; Ws, Ogden; Frank, JL

doi:10.2106/00004623-197658050-00023

Cited by 35 publications

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“…Cadaver studies have suggested that increased forces may lead to SCFE in these obese children [6]. It has also been hypothesized that SCFE may be due to a failure of the structural integrity of the physis secondary to a genetic or acquired problem, such as that associated with endocrine disorders [7][8][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

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Association between body mass index-for-age and slipped capital femoral epiphysis: The long-term risk for subsequent slip in patients followed until physeal closure

Aversano

Moazzaz

Scaduto

et al. 2016

Journal of Children's Orthopaedics

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BackgroundChildren who present with idiopathic slipped capital femoral epiphysis (SCFE) have an increased risk of developing bilateral disease. Predicting which patients will develop problems with bilateral hips is important for determining treatment algorithms. This is a retrospective observational study that evaluates the relationship and risk between body mass index (BMI)-for-age and unilateral and bilateral SCFE in patients followed until physeal closure.MethodsThis is a retrospective study of all patients with SCFE presenting to one institution from 1998–2005. Using the Center for Disease Control (CDC) references, BMI-for-age was calculated for each patient. The patients were followed up until complete closure of the bilateral proximal femoral physes, which was considered completion of the study. Statistical analysis for significant differences between groups was performed using the Kruskal–Wallis test for equality of populations. A logistic regression, controlling for age and gender, was used to identify BMI-for-age as a risk factor and to determine the significance of the odds ratios (ORs) for the relevant categorical variables—obese, overweight and healthy weight.ResultsEighty patients (56 male, 24 female) presented to a single institution between 1998 and 2005 with a diagnosis of SCFE. The mean age of patients was 12.2 years at initial presentation (range 8.5–16). Forty-eight patients (32 male, 16 female) presented with unilateral SCFE, with 22 of the 48 patients having a BMI for-age percentile ≥95 %. Thirty-two patients (24 male, 8 female) presented with bilateral SCFE, with 29 of the 32 patients having a BMI-for-age percentile ≥95 %. Patients with a BMI-for-age ≥95 % had a significantly increased risk of presentation with bilateral slips (OR 4.83; relative risk [RR] 3.01; p < 0.05]. All but one patient in this study with bilateral SCFE or unilateral SCFE with subsequent contralateral involvement had a BMI-for-age ≥85 % (44 out of 45 patients). Additionally, the overall risk of developing bilateral SCFE until physeal closure with a BMI-for-age ≥95 % was significantly increased (OR 3.84; RR 2.02; p < 0.05; number needed to treat [NNT] 3.01).ConclusionsPrevious work has established a relationship between BMI and SCFE. The CDC BMI-for-age growth charts more accurately measure obesity in the pediatric population compared to BMI and are therefore a more appropriate reference tool. This study demonstrates an association between obesity measured by BMI-for-age percentiles and SCFE. This study also demonstrates an association between BMI-for-age and risk for bilateral SCFE at presentation as well as overall incidence of developing bilateral SCFE in the obese pediatric population. By defining the at-risk population through BMI-for-age, physicians can screen the pediatric patient population and provide early strategies for therapeutic weight loss which may reduce the incidence of SCFE.

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Section: Introductionmentioning

confidence: 99%

“…The mean age of patients was 12.2 years at initial presentation (range 8. [5][6][7][8][9][10][11][12][13][14][15][16]. Forty-eight patients (32 male, 16 female) presented with unilateral SCFE, with 22 of the 48 patients having a BMI for-age percentile C95 %.…”

mentioning

confidence: 99%

Association between body mass index-for-age and slipped capital femoral epiphysis: The long-term risk for subsequent slip in patients followed until physeal closure

Aversano

Moazzaz

Scaduto

et al. 2016

Journal of Children's Orthopaedics

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“…The causes of SCFE are diverse, and atypical SCFE is associated with endocrine dysfunction, chronic renal insufficiency, and growth hormone therapy [33][34][35][36][37]. Recently, Halverson et al reported that elevated serum leptin levels, aside from BMI, have physiological effects related to the disease state of SCFE.…”

Section: Discussionmentioning

confidence: 99%

Relationship between Slip Severity and BMI in Patients with Slipped Capital Femoral Epiphysis Treated with In Situ Screw Fixation

Lim

Song

Kang

et al. 2023

JPM

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Background: Slipped capital femoral epiphysis (SCFE) is a hip disorder that occurs in adolescence before epiphyseal plate closure, causing anatomical changes in the femoral head. Obesity is known to be the single most important risk factor for idiopathic slipped capital femoral epiphysis (SCFE), which is highly related to mechanical factors. Meanwhile, as increased slip angle increases major complications in patients with SCFE, slip severity is an important factor to evaluate prognosis. In obese patients with SCFE, higher shear stress is loaded on the joint, which increases the likelihood of slip. The study aim was to assess the patients with SCFE treated with in situ screw fixation according to the degree of the obesity and to find any factors affecting the severity of slip. Methods: Overall, 68 patients (74 hips) with SCFE who were treated with in situ fixation screw fixation were included (mean age 11.38, range: 6–16) years. There were 53 males (77.9%) and 15 females (22.1%). Patients were categorized underweight, normal weight, overweight, and obese depending on BMI percentile for age. We determined slip severity of patients using the Southwick angle. The slip severity was defined as mild if the angle difference was less than 30 degrees, moderate if the angle difference was between 30 and 50 degrees, and severe if the angle difference was greater than 50 degrees. To examine the effects of several variables on slip severity, we used a univariable and multivariate regression analysis. The following data were analyzed: age at surgery, sex, BMI, symptom duration before diagnosis (acute, chronic, and acute on chronic), stability, and ability to ambulate at the time of the hospital visit. Results: The mean BMI was 25.18 (range: 14.7–33.4) kg/m2. There were more patients with overweight and obese than those with normal weight in SCFE (81.1% vs. 18.9%). We did not find significant differences between overall slip severity and degree of obesity or in any subgroup analysis. Conclusions: We did not find a relationship between slip severity and degree of obesity. A prospective study related to the mechanical factors affecting the slip severity according to the degree of obesity is needed.

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“…Zwar wurden mehrfach eine primäre und zentrale Hypothyreose vor oder unter Behandlung mit Schilddrüsenhormonen als Ursachen einer Epiphysenhüftkopflösung beschrieben (11,20), die betroffenen Patienten waren jedoch meist entweder massiv übergewichtig, oder befanden sich in der Frühphase der Schilddrüsenhormonsubstitutionstherapie mit beschleunigtem Längenwachstum im Sinne eines Aufholwachstums.…”

Section: Accelerated Slipping Of the Capital Femoral Epiphysis As A Cunclassified

Beschleunigung einer Epiphyseolysis Capitis Femoris Lenta als Komplikation einer Wachstumshormontherapie bei Hypophyseninsuffizienz

Schmid¹,

Bp²

1993

Klin Padiatr

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Slipped capital femoral epiphysis is a rare complication of growth hormone therapy. We report on a young man with pituitary insufficiency, diagnosed and treated with growth hormone at the age of 14 9/12. The patient withdrew from treatment after 6 months of growth hormone therapy without significant catch-up growth or complications. At the age of 21 8/12 years slipping of the left femoral capital epiphysis became apparent 2 1/2 months after treatment with growth hormone had been resumed in combination with low dose testosterone. Young adult patients with unfused epiphyses undergoing growth hormone substitution should be informed that pain in the lower extremities during therapy may be an important sign of a complication of growth hormone therapy. In this age group, patients complaining of pain in the limb should alert the physician to the possibility that a slipped capital femoral epiphysis may be present.

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Acquired hypothyroidism and slipped capital femoral epiphysis. Report of three cases

Cited by 35 publications

References 0 publications

Association between body mass index-for-age and slipped capital femoral epiphysis: The long-term risk for subsequent slip in patients followed until physeal closure

Association between body mass index-for-age and slipped capital femoral epiphysis: The long-term risk for subsequent slip in patients followed until physeal closure

Relationship between Slip Severity and BMI in Patients with Slipped Capital Femoral Epiphysis Treated with In Situ Screw Fixation

Beschleunigung einer Epiphyseolysis Capitis Femoris Lenta als Komplikation einer Wachstumshormontherapie bei Hypophyseninsuffizienz

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