Page 79 - Slipped Capital Femoral Epiphysis Pathogenetic and Clinical aspects

of these studies have to be interpreted with care. Hormone assays have changed
dramatically since 1988 and the number of patients in the second study was very
small.
Burrow et al. [55] investigated whether clinical characteristics (gender, height,
age and bilateral involvement) were useful as a screening test for patients
with underlying endocrinopathy. They found that 8 % of 166 patients had an endocrinopathy. Only short stature (below the tenth percentile for height) had
a high sensitivity for detecting an underlying endocrinopathy. Wells et al. [37]
documented, in 7 % of 131 patients with SCFE underlying endocrinopathies,
mainly hypothyroidism. Interestingly, all of the patients developed bilateral SCFE.
Jingushi et al. [56] examined the serum of 13 children with SCFE, 22 healthy children
and five children with cerebral palsy. In this study, significantly lower serum levels 4 of M-PTH (mid-portion PTH) and 1,25 di-hydroxyvitamin D was found, but this was
only transient.
In conclusion, there is insufficient evidence to justify extensive hormonal screening in patients with SCFE. Temporary hormonal changes preceding SCFE have been suggested, but large prospective studies are needed in order to obtain sufficient evidence for such a hypothesis.
As a recommendation, one could test for endocrine and metabolic changes in young children (<10 years of age for girls and <12 years of age for boys) and if there is short stature below the tenth percentile for height. The most commonly affected hormones in endocrinopathies are thyroid hormones and growth hormone.
Conclusion
Slipped capital femoral epiphysis (SCFE) is the result of high load across an abnormally weak physis. Children suffering from endocrinopathies, obesity and chronic diseases have an increased risk for the development of SCFE. However, the precise pathogenesis and aetiology of SCFE is still unknown. Many endocrine factors and hormones have been described that interact on the physis in several ways. Although studies which tested blood and urine samples in children with SCFE for hormonal abnormalities were inconclusive, the transient hormonal fluctuations during puberty might be the underlying factors.
Slipped Capital Femoral Epiphysis
77