IMPE Abstracts

Introduction: Slipped capital femoral epiphysis (SCFE) represents a spectrum of diseases with variable presentation and symptoms, chronicity, deformity, and long-term sequelae. Multiple primary endocrine abnormalities have been associated with the development of SCFE, such as hypothyroidism, hyperparathyroidism, renal osteodystrophy, and growth hormone deficiency, which involve, in most cases, atypical presentations of this disease, without the classic clinical features of typical SCFE (age at presentation between 10 and 16 years, associated with obesity and periods of rapid growth). A clinical case of an atypical SCFE is presented in a female young patient, with a recent diagnosis of hyperthyroidism.

Clinical case: A 9.9 years old girl, 142 cm (SDS +0.68), 33.2 kg, BMI 16.5 kg/m2 (SDS -0.1), breast I and pubic hair I tanner stage, with growth velocity 5.4 cm /year, previously healthy, presented with tremor, sweating, palpitations, increased appetite and exophthalmus. Negative anti-thyroperoxidase and anti-thyroglobulin antibodies, TSH: <0.015 uIU/ml, FT4 >6.9 ng/ml, T3 2.9 ng/ml, and TRAB >40 IU/L confirmed Graves disease. Treatment with thiamazole 0.9 mg/k/d and propranolol 2mg/k/d was started. Four months later, with TSH 0.04 uUI/ml, FT4 0.51 ng/ml, T3 1.6 ng/ml, 37.2 kg, 143.8 cm (SDS +0.7), BMI 18.9 kg/m2 (SDS +0,7), she presented pain in the right hip, ipsilateral claudication, and sleep conciliation disorder secondary to lower extremity pain. An anteroposterior, Lowenstein, and Cross-table X-ray of the hips shows widening of the right hip physis, relative decrease in epiphyseal height, positive Steel's sign, positive Trethowan's sign, and positive S sign, confirming a right SCFE. In situ fixation of the right hip and prophylactic fixation of the left hip was performed because atypical presentation of SCFE. The patient has evolved positively under kinesiotherapy. After seven months under treatment with thiamazole 0.75 mg/k/d, she increased 2.3 kg, 2.1 cm and exhibited TSH 35.1 uUI/ml, FT4 0.31 ng/ml. Levothyroxine 1.2 mg/k/d was added and thiamazole 0.35mg/kg/d was decreased. Eleven months after diagnosis and she is asympthomatic, TSH 2.1 uUI/ml, FT4 0.55 ng/ml, T3 1.8 ng/ml.

Conclusion: No cases of slipped capital femoral epiphysis associated with hyperthyroidism have been described. Hypertyrodism overtreatment can not be ruled out as a posible trigger in this case. Further studies are needed to determine if hyperthyroidism may be added as a risk factor for SCFE.