Endocrine Abstracts

JOINT2980

Synopsis: We present the case of a 34-year-old female with early onset bilateral femoral head necrosis, diagnosed with pituitary stalk interruption syndrome (PSIS). The patient’s medical history includes growth retardation from an early age, hip pain for nearly two years, and impaired consciousness for two weeks prior to admission. She had no history of alcohol use, autoimmune diseases, malignancies, or organ dysfunction.

Purpose: We present a case to highlight the importance of recognizing how growth disorders in children and adolescents can affect long-term health. It emphasizes the need for comprehensive medical education that bridges pediatric and adult specialties to reduce diagnostic delays in complex cases such as PSIS.

Medical history: The patient was diagnosed with growth hormone deficiency due to short stature at age 10.Her followed primary amenorrhea and absence of secondary sexual characteristics during puberty were not thoroughly investigated, obscuring the growth hormone deficiency due to long-term sex hormone deficiency and delayed skeletal closure.Eight years ago, she was diagnosed with hypothyroidism and began thyroid hormone replacement. Over the past two years, she developed bilateral groin and lower limb pain, initially treated as sacroiliitis. The pain progressed on the pain scale, leading to a duck-step gait and limited hip movement. Two weeks before hospitalization, she lost consciousness and was diagnosed with hypopituitarism and adrenal insufficiency. After replacement therapies, her consciousness returned, but the hip pain worsened with both hips in flexion and abduction. Upon admission, her bone age was assessed as 13-14 years, indicating delayed skeletal maturation. Frog-position DR and MRI imaging revealed bilateral femoral head avascular necrosis, with outward and upward displacement of the femoral necks, and pituitary MRI confirmed PSIS.

Diagnosis and treatment: The patient was diagnosed with PSIS, hypopituitarism, secondary adrenal insufficiency, hypogonadotropic hypogonadism, secondary hypothyroidism, growth hormone deficiency, and bilateral femoral head necrosis. Hormonal replacement therapy and bilateral artificial hip replacement were performed. Upon reevaluation of her medical history and bone age, the condition was likely a misdiagnosed case of slipped capital femoral epiphysis (SCFE).

Conclusion: This case underscores the importance of considering a patient’s developmental history, bone age, and hormonal status in diagnosing hip disorders in early adulthood. It highlights the need for improved medical education that integrates pediatric and adult specialties, especially in cases with atypical presentations or complex histories. Early recognition can lead to better outcomes in conditions like SCFE.

Keywords: Early onset avascular necrosis, Slipped Capital Femoral Epiphysis, Pituitary Stalk Interruption Syndrome