Slipped Capital Femoral Epiphysis Associated with Endocrinopathy

Shaw, K. Aaron; Shiver, A. Luke; Oakes, Tannur; Fletcher, Nicholas D.

doi:10.2106/jbjs.rvw.21.00188

Cited by 9 publications

(15 citation statements)

References 55 publications

(170 reference statements)

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“…7 Several studies have reported that 5% to 8% of SCFE cases are related to an endocrinopathy and that SCFEs are 6 times more common in a patient who has an endocrinopathy. 15 The most common endocrinopathies seen with SCFE are hypothyroidism, panhypopituitarism, growth hormone deficiency, and hypogonadism; hyperparathyroidism and hypoparathyroidism have also been reported. 15,16 Basic endocrine laboratory test results (Table 1) should be obtained if children are younger than 10 years or older than 15 years and/or are of short stature at presentation of SCFE, with a referral to endocrinology if findings are abnormal.…”

Section: Bone Age Assessmentmentioning

confidence: 99%

Orthopaedic Diagnoses in the Black Pediatric Population

Bridges

Agarwal

Raney

2023

J Am Acad Orthop Surg

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The Black pediatric population is one that has been historically underserved and continues to have unmet needs. Factors including lack of diversity in orthopaedic studies and in historical standards, such as bone age, may inadvertently lead to inferior care. There are certain conditions in this population for which the practicing orthopaedic surgeon should have a higher degree of suspicion, including slipped capital femoral epiphysis, Blount disease, and postaxial polydactyly. Systemic diseases with higher rates in this population have orthopaedic manifestations, including sickle cell disease, vitamin D deficiency, and obesity. Racial discrepancies in access to prenatal care can have orthopaedic consequences for babies, especially cerebral palsy and myelodysplasia. Racial discrepancy exists in evaluation for nonaccidental trauma. Increased awareness of these issues better prepares practitioners to provide equitable care. D r. Martin Luther King Jr. stated that "of all forms of inequity, injustice in health care is the most shocking and inhumane." 1 Differences in care exist at all levels of the healthcare delivery system based on socioeconomic status and race. Access to primary care, treatment in the emergency department, and hospital treatment have all been found to have racial discrepancies, with Black children most commonly ending up with less care and poorer quality of care. 2 In the emergency department, patient race can affect analgesia, triage scores, wait times, treatments, diagnostic procedure utilization, rates of patients leaving without being seen, and patient experiences. 3 One particularly problematic area is in the treatment of pain. Opioid treatment of pain in adolescents has been found to favor treating non-Hispanic White patients over minorities. A study by Phan et al 2 demonstrated variability in treating pain based on race for the same diagnoses. These trends persist into adulthood, with pain in the Black population being ignored or undertreated across fields and through the end of life. Extensive work has been done in the past 5 years looking at persistent racial disparities in pediatric surgical outcomes and anesthesia. 4 Variability in surgical outcome has previously been attributed to baseline preoperative characteristics. Recent studies demonstrate that even when controlling for American Society of Anesthesiologists (ASA) scores, Black children have

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Section: Bone Age Assessmentmentioning

confidence: 99%

Orthopaedic Diagnoses in the Black Pediatric Population

Bridges

Agarwal

Raney

2023

J Am Acad Orthop Surg

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“…Supporting material provided by the authors is posted with the online version of this article as a data supplement at jbjs.org (http://links.lww.com/JBJS/H789). n Sunghyun Hwang, MD 1 Yun Jeong Lee, MD 2 Mi Hyun Song, MD 1,3 Tae-Joon Cho, MD 1,3 In Ho Choi, MD 3 Chang Ho Shin, MD…”

Section: Appendixmentioning

confidence: 99%

Incidence and Clinical Characteristics of Slipped Capital Femoral Epiphysis in Patients with Endocrinopathy

Hwang,

Lee,

Song

et al. 2023

Journal of Bone and Joint Surgery

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Background: Endocrinopathy is a risk factor for slipped capital femoral epiphysis (SCFE). We aimed to determine (1) the incidence of endocrinopathy-associated SCFE compared with that of non-endocrinopathy-associated SCFE, (2) whether the incidence of SCFE increases with the number of deficient hormones, and (3) the clinical characteristics of endocrinopathy-associated SCFE. Methods: We conducted a population-based cohort study using a nationwide database in South Korea. All new diagnoses of endocrinopathy or SCFE between 2002 and 2019 in children born between 2002 and 2005 were identified. The incidence of SCFE was calculated for each type of endocrinopathy. The trend of the incidence of SCFE relative to the number of deficient hormones was analyzed. The male:female ratio was compared between endocrinopathy-associated SCFE and non-endocrinopathy-associated SCFE. For endocrinopathy-associated SCFE, the time between the diagnoses of SCFE and endocrinopathy was evaluated. Results: The incidence of SCFE was higher in children with endocrinopathy than in those without endocrinopathy (37.1/100,000 versus 9.0/100,000 children) (relative risk, 4.1 [95% confidence interval, 2.8-6.1]). Among various endocrinopathies, growth hormone deficiency showed the highest incidence of SCFE (583.8/100,000 children). The Cochran-Armitage test showed a linear trend, with an increased number of deficient hormones being associated with a higher incidence of SCFE (p < 0.001). Male sex was dominant in the non-endocrinopathy-associated SCFE group (73%; 117 of 161), whereas female sex was dominant in the endocrinopathy-associated SCFE group (53%; 16 of 30) (p = 0.009). Twenty-two of the 30 cases of endocrinopathy-associated SCFE were diagnosed after the diagnosis of endocrinopathy, with a median time of 3.6 years between the diagnoses. Six (27%) of these 22 children developed SCFE >5 years after the diagnosis of endocrinopathy. Conclusions: The incidence of SCFE was approximately 4 times higher in children with endocrinopathy than in those without endocrinopathy. The risk of SCFE increased with an increased number of deficient hormones. Long-term monitoring of SCFE occurrence in children with endocrinopathies is strongly recommended. Level of Evidence: Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.

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“…5 One of the risk factors for developing SCFE includes a height below the 10th percentile before the age of 10 years or after the 16th birthday. 6…”

Section: Introductionmentioning

confidence: 99%

“…5 One of the risk factors for developing SCFE includes a height below the 10th percentile before the age of 10 years or after the 16th birthday. 6 In addition to SCFE, GH therapy could be associated with other various orthopaedic complications including scoliosis, and carpal tunnel syndrome. Therefore, it is important to provide proper counseling before commencing the treatment, followed by close clinical monitoring during treatment with GH.…”

Section: Introductionmentioning

confidence: 99%

Slipped Capital Femoral Epiphysis after 2 Months from Starting Growth Hormone Therapy

Abdullah,

Alsaffar

2023

Journal of Diabetes and Endocrine Practice

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Recombinant growth hormone (GH) is a widely used hormonal therapy for children and adolescents with GH deficiency or short stature related to certain conditions. Generally, GH therapy has a good safety profile; however, it could have rare but significant orthopaedic complications including slipped capital femoral epiphysis (SCFE). Pediatric endocrinologists are aware of these possible complications, and they are responsible for appropriately counseling their patients before commencing this hormone. However, the pediatric endocrinologist may not be the first clinician who encounters the orthopaedic complications of GH, as the patient may seek an emergency medical opinion from people from other specialties. Here, we report the case of a 13-year-old Iraqi adolescent boy who presented with limping that appeared only 2 months after receiving GH (0.035 mg/kg/d). He was diagnosed with SCFE in a relatively very short time after commencement of the treatment. Despite this, the patient was not considered to be at high risk of SCFE. A careful evaluation of SCFE in patients complaining of a limp or hip and knee pain during GH therapy is highly recommended.

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Slipped Capital Femoral Epiphysis Associated with Endocrinopathy

Cited by 9 publications

References 55 publications

Orthopaedic Diagnoses in the Black Pediatric Population

Orthopaedic Diagnoses in the Black Pediatric Population

Incidence and Clinical Characteristics of Slipped Capital Femoral Epiphysis in Patients with Endocrinopathy

Slipped Capital Femoral Epiphysis after 2 Months from Starting Growth Hormone Therapy

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