Introduction: Growth without growth hormone is seen also in patient with craniopharyngioma. We just speculate what anabolic factors might be involved in this process. However, oestrogen through its receptors lead to epiphyseal fusion. In this case report we would like to present the patient with bilateral slipped femoral epiphysis (SFE) and interventions made at tertiary health care level.
Case report: 20-years-old female, operated from craniopharyngioma when was 10 year, bogy height 167 cm, body weight 71.8 kg, not regularly on levothyroxine 50 gr, in December 2013 presented as pain in right hip, on X-ray SFE, and osteosynthesis was performed. In July 2013 similar clinical picture but on left side. Patient was sended at tertiary level. After multislice CT scanning same surgical procedure performed on left femur with three screws. Then patient was moved on endocrinology department. Clinically, according to sex characteristics, patient was Tanner I stage, without measurable values of growth hormone, insulin like growth factor I, gonadotropins and estrogens, insulinaemia 17.3 mU/l, blood glucose 4.5 mmol/l. On X-ray of the left hand skeletal age was 12 year. Estrogen therapy started with 0. mg etinil estradiol and after 5 months increased on 2 mg estradiol, 21 and 7 days pause. Skeletal age at 5 m, 10 m and 13 were 13 years 6 months, 14 year, 1516 year respectively. Increased markers of bone resorption (cross laps) returned back into normal range. DEXA scan of lumbar spine was improved from 3.2 T-score onto 2.8 in just 6 month period. Body height was changed from 167.5 cm to on 171 cm and body weight from 67.580 kg.
Conclusions: After the operation of craniopharyngioma and growth without growth hormone we have to follow skeletal growth and on time introduce sex hormones. Later, in young adults we have to consider a small dosages of growth hormone to improve their body composition.