Curriculum · Metabolic and Endocrine and Diabetes Mellitus
Growth hormone therapy and slipped capital femoral epiphysis
What it is
Slipped capital femoral epiphysis (SCFE) is displacement of the femoral head epiphysis postero-inferiorly, and it is the most common hip disorder in adolescents. Treatment with growth hormone (GH) carries the risk of an increased incidence of slipped capital femoral epiphysis, especially in rapidly growing adolescents. An adolescent with idiopathic growth hormone deficiency who is started on biosynthetic recombinant DNA-derived GH is therefore at high risk for it.
Causes and risk
The age band given for SCFE is 8-15 years, and elsewhere 10-15 years. It is more common in obese children, and although it has in the past been more common in boys than in girls, that prevalence is changing due to the rise in obesity. It is rarely associated with trauma, overuse, or prior illness. Growth hormone treatment is an added risk, especially during rapid growth.
How it presents
SCFE should be suspected in an adolescent who has unexplained pain in the hip, groin, thigh, or knee, and the pain may be felt in the medial thigh. A new limp together with pain in the groin, hip, thigh, or knee is what should prompt radiographs. On examination the most indicative sign is limited internal rotation of the involved hip, which is also described as loss of internal rotation of the leg in flexion.