Abstract
Slipped capital femoral epiphysis (SCFE) is a relatively common hip disorder often seen in overweight, peripubertal children. Although the exact etiology is uncertain, it is generally accepted that underlying endocrinopathies play a role in the pathogenesis. Hypothyroidism is the endocrine disorder cited most commonly in association with SCFE, and patients often have no history of thyroid dysfunction at the time of presentation. Despite being a well-recognized risk factor, recommendations for screening thyroid function in patients with typical presentations of SCFE have not been deemed cost-effective; however, there is data to support screening for hypothyroidism in patients with atypical presentations of SCFE or short stature. Hypothyroidism may have a significant impact on healing and bone union after surgical management of SCFE and there is a paucity of case reports in the literature describing potential peri- and postoperative complications. We performed a systematic review of the literature of all reported cases of SCFE with associated hypothyroidism using the search terms, which demonstrated a physiologic relationship between hypothyroidism and SCFE. Two case reports of SCFE in patients with hypothyroidism and associated complications are presented with the literature review. There is a physiologic relationship between thyroid dysfunction and SCFE, and we postulate that profound hypothyroidism may contribute to delayed healing or nonunion in patients undergoing operative management. We support the recommendation to screen patients with short stature, atypical presentation of SCFE, or perisistent nonunion after surgery. In cases of hypothyroidism, we recommend thyroid hormone replacement and laboratory confirmation of return to euthyroid state prior to operative intervention.
References
1. Speer, DP. The John Charnley Award Paper. Experimental epiphysiolysis: etiologic models slipped capital femoral epiphysis. The hip: proceedings of the tenth open scientific meeting of the Hip Society. St. Louis, MO: C.V. Mosby Company, 1982:68–88.Search in Google Scholar
2. Pritchett JW, Perdue KD. Mechanical factors in slipped capital femoral epiphysis. J Pediatr Orthop 1988;8:385–8.10.1097/01241398-198807000-00001Search in Google Scholar PubMed
3. Heyerman W, Weiner D. Slipped epiphysis associated with hypothyroidism. J Pediatr Orthop 1984;4:569–73.10.1097/01241398-198409000-00008Search in Google Scholar
4. Mann DC. Endocrine disorders and orthopedic problems in children. Curr Opin Pediatr 1996;8:68–70.10.1097/00008480-199602000-00015Search in Google Scholar PubMed
5. Loder RT, Wittenberg B, DeSilva G. Slipped capital femoral epiphysis associated with endocrine disorders. J Pediatr Orthop 1995;15:349–56.10.1097/01241398-199505000-00018Search in Google Scholar PubMed
6. Mann DC, Weddington J, Richton S. Hormonal studies in patients with slipped capital femoral epiphysis without evidence of endocrinopathy. J Pediatr Orthop 1988;8:543–5.10.1097/01241398-198809000-00009Search in Google Scholar PubMed
7. Wilcox PG, Weiner DS, Leighley B. Maturation factors in slipped capital femoral epiphysis. J Pediatr Orthop 1988;8:196–200.10.1097/01241398-198803000-00013Search in Google Scholar
8. Wells D, King JD, Roe TF, Kaufman FR. Review of slipped capital femoral epiphysis associated with endocrine disease. J Pediatr Orthop 1993;13:610–14.10.1097/01241398-199313050-00011Search in Google Scholar
9. Razzano CD, Nelson C, Eversman J. Growth hormone levels in slipped capital femoral epiphsys. J Bone Joint Surg Am 1972;54:1224–6.10.2106/00004623-197254060-00009Search in Google Scholar
10. El Scheich T, Marquard J, Westhoff B, Krauspe R, Schneider A, et al. Approach to the management of slipped capital femoral epiphysis and primary hyperparathyroidism. J Pediatr Endocrinol Metab 2012;25:407–12.10.1515/jpem-2012-0003Search in Google Scholar
11. Kempers MJ, Noordam C, Rouwe CW, Otten BJ. Can GnRH-agonist treatment casuse slipped capital femoral epiphsis? J Pediatr Endocrinol Metab 2001;14:729–34.10.1515/JPEM.2001.14.6.729Search in Google Scholar
12. Harris WR. The endocrine basis for slipping of the upper femoral epiphysis. An experimental study. J Bone Joint Surg [Br] 1950;32:5–11.10.1302/0301-620X.32B1.5Search in Google Scholar
13. Loder RT. The demographics of slipped capital femoral epiphysis. An international multicenter study. Clin Orthop 1996;322: 8–27.10.1097/00003086-199601000-00003Search in Google Scholar
14. McAfee PC, Cady RB. Endocrinologic and metabolic factors in atypical presentations of slipped capital femoral epiphysis. Report of four cases and review of the literature. Clin Orthop 1983;180:188–97.10.1097/01241398-198403000-00044Search in Google Scholar
15. Kelsey JL. The incidence and distribution of slipped capital femoral epiphysis in Connecticut. J Chronic Dis 1971;23:567–78.10.1016/0021-9681(71)90132-9Search in Google Scholar
16. Jerre R, Billing L, Hansson G, Wallin J. The contralateral hip in patients primarily treated for unilateral slipped upper femoral epiphysis. J Bone Joint Surg 1994;76-B:563–7.10.1302/0301-620X.76B4.8027141Search in Google Scholar
17. Loder RT, Arronsson DD, Dobbs MB, Weinstein SL. Slipped capital femoral epiphysis. J Bone Joint Surg Am 2000;82:1170–88.10.2106/00004623-200008000-00015Search in Google Scholar
18. Kohl BA, Schwartz S. Surgery in the patient with endocrine dysfunction. Med Clin North Am 2009;93:1031–47.10.1016/j.mcna.2009.05.003Search in Google Scholar PubMed
19. Benvenga S, Campenni A, Ruggeri RM, Trimarchi F. Clinical review 113: hypopituitarism secondary to head trauma. J Clin Endocrinol Metab 2000;85:1353–61.10.1210/jcem.85.4.6506Search in Google Scholar PubMed
20. Wellby ML, Kennedy JA, Barreau PB, Roediger WE. Endocrine and cytokine changes during elective surgery. J Clin Pathol 1994;47:1049–51.10.1136/jcp.47.11.1049Search in Google Scholar PubMed PubMed Central
21. Gogakos AI, Duncan Bassett JH, Williams GR. Thyroid and bone. Arch Biochem Biophys 2010;503:129–36.10.1016/j.abb.2010.06.021Search in Google Scholar PubMed
22. Urabe K, Hotokebuchi T, Oles KJ, Bronk JT, Jingushi S, et al. Inhibition of endochondral ossification during fracture repair in experimental hypothyroid rats. J Orthop Res 1999;17: 920–5.10.1002/jor.1100170617Search in Google Scholar
23. Fadaei F, Norouzian M, Azizi F. Effect of hypothyroidism on bone repair in mature female rats. J Endicrinol Metab 2005;1:126–9.Search in Google Scholar
24. Loftus MJ, Peterson LJ. Delayed healing of mandibular fracture in idiopathic myxedema. Oral Surg Oral Med Oral Pathol 1979;47:233–7.10.1016/0030-4220(79)90147-6Search in Google Scholar
25. Papavasiliou KA, Kirkos JM, Kapetanos GA, Pournaras J. Potential influence of hormones in the development of slipped capital femoral epiphysis: a preliminary study. J Pediatr Orthop B 2007;16:1–5.10.1097/BPB.0b013e328010b73dSearch in Google Scholar PubMed
26. Lewinson D, Bialik GM, Hochberg Z. Differential effects of hypothyroidism on the cartilage and the osteogenic process in the mandibular condyle: recovery by growth hormone and thyroxine. Endocrinology 1994;135:1504–10.10.1210/endo.135.4.7925111Search in Google Scholar PubMed
27. Tank JC, Weiner DS, Jacquet R, Childs D, Ritzman TF, et al. The effects of hypothyroidism on the proximal femoral physis in miniature swine. J Orthop Res. 2013;31:1986–91.10.1002/jor.22467Search in Google Scholar PubMed
28. Brenkel IJ, Dias JJ, Iqbal SJ, Gregg PJ. Thyroid hormone levels in patients with slipped capital femoral epiphysis. J Pediatr Orthop 1988;8:22–5.10.1097/01241398-198801000-00006Search in Google Scholar PubMed
29. Brenkel IJ, Dias JJ, Davies TG, Iqbal SJ, Gregg PJ. Hormone status in patients with slipped capital femoral epiphysis. J Bone Joint Surg Br 1989;71:33–8.10.1302/0301-620X.71B1.2521639Search in Google Scholar PubMed
30. Burrow SR, Alman B, Wright JG. Short stature as a screening test for endocrinopathy in slipped capital femoral epiphysis. J Bone Joint Surg 2001;83-B:263–8.10.1302/0301-620X.83B2.0830263Search in Google Scholar
31. Wilson PD, Jacobs B, Schecter L. Slipped capital femoral epiphysis: an end-result study. J Bone Joint Surg 1965;47: 1128–45.10.2106/00004623-196547060-00002Search in Google Scholar
32. Zwillich CW, Pierson DJ, Hofeldt FD, Lufkin EG, Weil JV. Ventilatory control in myxedema and hypothyroidism. N Engl J Med 1975;292:662–5.10.1056/NEJM197503272921302Search in Google Scholar PubMed
33. Wilson WR, Bedell GN. The pulmonary abnormalities in myxedema. J Clin Invest 1960;39:42–55.10.1172/JCI104025Search in Google Scholar
34. Connery LE, Coursin DB. Assessment and therapy of selected endocrine disorders. Anesthesiol Clin North America 2004;22:93–123.10.1016/S0889-8537(03)00111-1Search in Google Scholar
©2016 by De Gruyter
