Slipped upper femoral epiphysis and primary juvenile hypothyroidism

Abstract

The pathogenesis of slipped upper femoral epiphysis is unknown but the condition has been linked with various endocrine disorders. Nine patients with slipped epiphyses in association with primary juvenile hypothyroidism are presented. In all patients, slipping occurred or symptoms developed in the affected hip before the hypothyroidism was diagnosed. A generalised pathology was suggested by the absence of trauma (8 patients), by bilateral slipping (6 patients), and by obesity and short stature in all patients. All cases had delayed skeletal maturation and characteristic metaphysial changes were seen on their radiographs. The clinical diagnosis of juvenile hypothyroidism can be difficult but it merits consideration in patients who have a slipped upper femoral epiphysis in association with short stature, obesity, delay in skeletal maturity, or any one of these.

Slipped capital femoral epiphysis and hypothyroidism in a young adult: a case report

“…Thyroid hormone deficiency can play a significant role in reducing the stability of the growth plate and then contribute to the pathogenesis of the proximal femoral glide [12, 13]. In examining patients with thyroid hormone disorders, it is important to distinguish primary from secondary hypothyroidism.…”

Short stature as a screening test for endocrinopathy in slipped capital femoral epiphysis

“…In the hypothyroid child, degeneration of chondrocytes is accelerated and mineralisation of matrix is enhanced, but ossification of the mineralised matrix is inhibited. 1,3,4,8,9,[12][13][14] In normal children without an endocrinopathy, the epiphysis is anchored to the metaphysis by interdigitation of the calcified lattice with the opposing filamentous extensions of osteogenic marrow. In a post-mortem specimen of an untreated cretin, the epiphysiometaphyseal junction was noted to consist of a lattice of solidly calcified cartilaginous matrix, as opposed to the normal 'mesh type' union of bone and cartilage.…”

“…1,3,4,8,9,[12][13][14] Some patients with an endocrinopathy will present with slipped capital femoral epiphysis before recognition of their endocrinopathy. All nine cases in the study by Puri et al 12 developed a slip or had symptoms before the diagnosis of hypothyroidism was made, although two had documented symptoms two and three months before being diagnosed with hypothyroidism. In three of 85 patients in the study by Loder et al 14 the diagnosis of an endocrine problem was not made when they presented with a slipped capital femoral epiphysis.…”

Hashimoto's hypothyroidism presenting with SUFE (slipped upper femoral epiphysis)

“…SUFE has historically been linked with endocrinopathies, especially hypopituitarism and hypothyroidism 2. In around 30% of patients with SUFE the contralateral hip also becomes involved over time and fixing the other hip prophylactically (figure 3) is often favoured 3.…”