Endocrine Abstracts

Introduction: In general population, slipped capital femoral epiphysis (SCFE) is a rare hip condition, characterized by posteroinferior displacement of femoral epiphysis from metaphysis through an open physis. This commonly occurs in adolescents with average age at onset being 13.5 years in males and 12 years in females. There are several risk factors, including obesity; calcium disorders; genetic disorders (Marfan syndrome, Down syndrome); and endocrine disorders (hypothyroidism, hypogonadism, growth hormone deficiency, panhypopituitarism, hyperparathyroidism, and pituitary tumours). Our case is a 19-year-old gentleman who was initially diagnosed as left SCFE, treated with in-situ fixation, 7 weeks later, developed pituitary apoplexy and panhypopituitarism secondary to a pituitary macroadenoma.

Case presentation: A 19-year-old gentleman initially presented with limping and left groin pain, was diagnosed as left SCFE. In-situ fixation was done by orthopedics team. 7 weeks later, presented with severe headache, and vomiting. Found to have pituitary macroadenoma with apoplexy, panhypopituitarism, smaller and younger appearance than his age with lack of secondary sexual characteristics. Hydrocortisone, levothyroxine, and testosterone replacement (Testogel) were commenced. Then reviewed in Endocrine clinic and a bone age assessment was performed, which showed a delayed bone age. Adjusting testosterone replacement from Testogel to injection helped him to achieve adult height and secondary sexual characteristics.

Discussion: Although the exact pathophysiology of SCFE is not well understood, patients who first presented with SCFE in post-adolescence need evaluation as endocrinopathies are the most common causes in these atypical age groups from delayed epiphyseal fusion. Our gentleman might have developed SCFE from his pituitary macroadenoma, which later became evident as pituitary apoplexy associated with panhypopituitarism.

Conclusion: All delayed-onset SCFE should be evaluated for endocrine disorders pre-operatively to prevent adrenal crisis during the fixation procedure. Similarly, patients with known endocrine abnormalities who report hip, or groin pain should be evaluated for SCFE regardless of their age.