Slipped capital femoral epiphysis in an adolescent with congenital adrenal hyperplasia: A case report

Abstract

In previous reports, hypothyroidism, hypopituitrism, and hypogonadism were common endocrine causes of SCFE, but this is the first time that congenital adrenal hyperplasia has been observed. As such, patients who have undergone long-term endocrine treatment for congenital adrenal hyperplasia could potentially be subjected to a higher risk for SCFE.

Keywords: adrenal hyperplasia; congenital; epiphyses; slipped.

FIGURE 1

Timeline of this case report. A Chinese boy was diagnosed with CAH when he was 75 weeks old and subsequently initiated with an endocrine therapeutic strategy. At 5 years old, GnRH analogs and growth hormone therapy were added to improve height. The boy suffered from right SCFE without trauma when he was 12 years old. He was then treated with the modified Dunn's procedure. ANFH occurred 6 months postoperatively. Four years after modified Dunn's procedure, the patient underwent right total hip arthroplasty (THA). So far, a follow‐up of one and a half years has shown good prosthesis position and function.

FIGURE 2

(A) Height growth curve and (B) weight growth curve displayed the patient's height and weight change from 5 to 12 years old. It can be seen from the height growth chart that at 5 years old, the patient had a height advantage over that of his peers, but as he got older, the advantage diminished. Serial height and weight measurements of the patient were plotted using the standard growth chart (developed by the Capital Institute of Pediatrics).

FIGURE 3

An anteroposterior radiograph (A) and a frog position radiograph (B) of the pelvis showed right slipped capital femoral epiphysis.

FIGURE 4

(A) Axial, (B) coronal, (C) sagittal computed tomography (CT) scan, and (D) three‐dimensional reconstruction displayed right femoral epiphysis positions.

FIGURE 5

Adrenal CT showed left adrenal hyperplasia. (A) Axial and (B) coronal CT scan of left adrenal. (C) Axial and (D) coronal CT scan of right adrenal. The size of the left adrenal gland was significantly larger than that of the right. The white arrow represents the left or the right adrenal.

FIGURE 6

Anteroposterior radiograph of the left wrist prompted that his bone age was 13 years.

FIGURE 7

(A) The postoperative anteroposterior radiograph of the pelvis showed a good rehabilitation of epiphysis after modified Dunn's procedure. (B) At the 6‐month follow‐up, the patient suffered from right ANFH. (C–F) X‐ray images of right ANFH during follow‐up at 2 years, 2.5 years, 3.5 years, and 4 years postoperatively. (G) Four years after modified Dunn's procedure, the patient underwent right THA. (H) So far, follow‐ups of 6 months and (I) one and a half years have shown good prosthesis position.