Page 80 - Slipped Capital Femoral Epiphysis Pathogenetic and Clinical aspects

Chapter 4
Children with overt endocrinopathies like hyper- and hypothyroidism, hyperparathyroidism, hypogonadal states and hypopituitarism seem to have a higher chance of developing SCFE. This review shows that the growth hormone– insulin-like growth factor 1 (GH-IGF-1) axis, sex hormones, leptin, thyroid hormone with Indian hedgehog– parathyroid hormone-related hormone (IHH–PTrH) feed- back loop and glucocorticoids are inter-related and have direct as well as indirect effects on the human physis.
In children with chronic diseases, the use of glucocorticoids and the presence of inflammation, malnutrition and metabolic acidosis influence the extracellular matrix (ECM), the quality of the chondrocytes, as well as the activity of the GH- IGF-1 axis.
SCFE is most likely the result of a multi-factorial event during adolescence when height and weight increase dramatically and the delicate balance in the various hormonal equilibria can be disturbed. Up to now, there are no screening or diagnostic tests available to predict patients at risk for SCFE.
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