J Korean Orthop Assoc.  2009 Oct;44(5):565-569. 10.4055/jkoa.2009.44.5.565.

Bilateral Slipped Capital Femoral Epiphysis Due to Primary Hyperparathyroidism: A Case Report

• Kim TS
• Choi WS

• KMID: 2186317
• DOI: http://doi.org/10.4055/jkoa.2009.44.5.565

Abstract

Slippage of the upper femoral epiphysis can occur in association with endocrine disorder. A 14-year-old male patient, who complained of pain on multiple joints including both hips, was diagnosed with bilateral slipped femoral epiphysis due to primary hyperparathyroidism. At a single operation, the epiphyses were pinned-in situ, and the tumor was removed. After parathyroidectomy, the calcium and the parathyroid hormone levels promptly resolved. The pinning-in situ of both femoral heads was done for the purpose of preventing further displacement of the femoral epiphyses, and we aimed for epiphysiodesis. The permanent biopsy of the tumor was parathyroid adenoma. The physes of both femoral heads were closed and the widened physes of both distal tibias resolved postoperatively.

Keyword

Slipped capital femoral epiphysis; Primary hyperparathyroidism

MeSH Terms

Adolescent
Biopsy
Calcium
Displacement (Psychology)
Epiphyses
Head
Hip
Humans
Hyperparathyroidism, Primary
Joints
Male
Parathyroid Hormone
Parathyroid Neoplasms
Parathyroidectomy
Slipped Capital Femoral Epiphyses
Tibia
Calcium
Parathyroid Hormone

Figure

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  Fig. 1 Both hip anteroposterior radiograph showing widening of both femoral epiphyseal plate.

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  Fig. 2 (A) Right ankle anteroposterior radiograph showing widening of distal tibial epiphyseal plate. (B) The epiphyseal plate of right distal tibia narrowed at postoperatively nine months later.

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  Fig. 3 The axial image of pelvic bone computerized tomograph showing widening of both femoral epiphyseal plate and mild posterior migration of both femoral epiphyses.

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  Fig. 4 Parathyroid scan showing hot uptake on right lower parathyroid gland.

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  Fig. 5 The epiphyseal plates of both femoral head were pinned in situ.

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  Fig. 6 The pins in both femoral head were removed at postoperatively nine months later. And the follow-up radiograph showing completely closing femoral capital epiphyseal plates.

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  Fig. 7 (A) The subperiosteal resorptions of phalanges were shown preoperatively. (B) The subperiosteal resorption of phalanges were reduced after operation.

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  Fig. 8 (A) The lamina dura in teeth was absent preoperatively. (B) The lamina dura in teeth were newly developed postoperatively.

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