Occurrence of Slipped Capital Femoral Epiphysis in Children Undergoing Gonadotropin-Releasing Hormone Agonist Therapy for the Treatment of Central Precocious PubertyInman M.a · Hursh B.E.b · Mokashi A.a, c · Pinto T.a, c · Metzger D.L.b · Cummings E.A.a, c
aDepartment of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, N.S., bDivision of Pediatric Endocrinology, BC Children's Hospital, University of British Columbia, Vancouver, B.C., and cDivision of Pediatric Endocrinology, IWK Health Centre, Dalhousie University, Halifax, N.S.,Canada
Elizabeth A. Cummings
Division of Pediatric Endocrinology, IWK Health Centre
PO Box 9700, 5850/5980 University Avenue
Halifax, NS B3K 6R8 (Canada)
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Background: Obesity, age and hormone imbalances including hypothyroidism and growth hormone deficiency and therapy, but not gonadotropin-releasing hormone agonist (GnRHa) therapy, have been identified as risk factors for slipped capital femoral epiphysis (SCFE). Five of 7 reported cases describe SCFE in children shortly after GnRHa therapy cessation. Methods: We report 3 cases of SCFE that occurred in children on GnRHa therapy for the treatment of central precocious puberty (CPP) and discuss possible promoting factors. Results: An otherwise healthy 8.75-year-old girl [body mass index (BMI) Z score +1.75] developed SCFE 6.75 years into GnRHa therapy for idiopathic CPP. A second girl (with a history of acute lymphoblastic leukemia requiring total body irradiation) was 10.6 years old (BMI Z score +1.06) when she developed SCFE 3.3 years into GnRHa therapy. The third case was an 8.75-year-old female with CPP secondary to a hypothalamic hamartoma (BMI Z score +1.65) who developed bilateral SCFE 5.6 years into therapy. Conclusion: Increasing evidence suggests an association between GnRHa therapy for CPP and the occurrence of SCFE. We suggest that a lack of adequate sex hormone exposure at a ‘critical period' of bone formation may result in a weakened epiphysis that becomes susceptible to slipping.
© 2013 S. Karger AG, Basel
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