CLINICAL AND LABORATORY OBSERVATIONS
Slipped capital femoral epiphysis during treatment with recombinant growth hormone for isolated, partial growth hormone deficiency V i j a y a P r a s a d , MB,BS, F e n e l l a G r e i g , MD, DPhil,* W i l l i a m Bastian, MD, S a l v a d o r C a s t e l l s , ME), C h r i s t i n a J u a n , MS, a n d T h e o d o r e W. A v R u s k i n , ME) From the Divisions of Pediatric Endocrinology and Metabolism, Department of Pediatrics, The Brookdale Hospital Medical Center and the State University of New York Health Science Center at Brooklyn
Slipped capital femoral epiphysis occurs most commonly in children during the peripubertal period and is associated with trauma or obesity I or, less frequently, with endocrine imbalance, including growth hormone deficiency25 and hypothyroidism.6 In a retrospective study of children with GH deficiency, 21 children with SCFE were identified among 7719 patients on GH registries. This cumulative incidence of 272 per 100,000 significantly exceeded the expected values (45/100,000 girls and 123/100,000 boys5,7). The majority of cases previously described had GH deficiency associated with brain tumors, structural abnormalities, or trauma. 24 All of 11 children with additional endocrine data were described as having multiple pituitary deficiencies.4, 5 Pituitary-derived GH was available for only the most severely affected patients. Currently, children with partial GH deficiency or other forms of short stature may receive GH treatment. We report two patients with isolated, idiopathic GH deficiency and one with Turner syndrome in whom SCFE developed during treatment with recombinant GH. METHODS Evaluation for short stature included one or more standard GH provocative tests with arginine, 0.5 gm/kg administered as an intravenous infusion for 30 minutes, insulin-induced hypoglycemia, 0.l U/kg administered as an intravenous bolus, or levodopa, 500 mg administered orally. Deficiency of GH was defined as a peak GH response _< 10.0 Supported in part by the HANID Foundation (Dr. AvRuskin). Submitted for publication July 11, 1989; accepted Oct. 6, 1989. Reprint requests: Vijaya Prashd, MB, BS, Interfaith Medical Center, 1545 Atlantic Ave., Brooklyn, NY 11213. *Current address: Mount Sinai Medical Center, Box 1198, One Gustave L. Levy Place, New York, NY 10029. 9/22/17101
ng/ml, measured by double-antibody radioimmunoassay. Spontaneous GH secretion was evaluated by continuous blood withdrawal by pump, with collection of samples every 30 minutes for 24 hours. Deficient response was defined by this integrated concentration of GH of 2 SD for chronologic age, and growth rates were ~
Slipped capital femoral epiphysis during treatment with recombinant growth hormone for isolated, partial growth hormone deficiency V i j a y a P r a s a d , MB,BS, F e n e l l a G r e i g , MD, DPhil,* W i l l i a m Bastian, MD, S a l v a d o r C a s t e l l s , ME), C h r i s t i n a J u a n , MS, a n d T h e o d o r e W. A v R u s k i n , ME) From the Divisions of Pediatric Endocrinology and Metabolism, Department of Pediatrics, The Brookdale Hospital Medical Center and the State University of New York Health Science Center at Brooklyn
Slipped capital femoral epiphysis occurs most commonly in children during the peripubertal period and is associated with trauma or obesity I or, less frequently, with endocrine imbalance, including growth hormone deficiency25 and hypothyroidism.6 In a retrospective study of children with GH deficiency, 21 children with SCFE were identified among 7719 patients on GH registries. This cumulative incidence of 272 per 100,000 significantly exceeded the expected values (45/100,000 girls and 123/100,000 boys5,7). The majority of cases previously described had GH deficiency associated with brain tumors, structural abnormalities, or trauma. 24 All of 11 children with additional endocrine data were described as having multiple pituitary deficiencies.4, 5 Pituitary-derived GH was available for only the most severely affected patients. Currently, children with partial GH deficiency or other forms of short stature may receive GH treatment. We report two patients with isolated, idiopathic GH deficiency and one with Turner syndrome in whom SCFE developed during treatment with recombinant GH. METHODS Evaluation for short stature included one or more standard GH provocative tests with arginine, 0.5 gm/kg administered as an intravenous infusion for 30 minutes, insulin-induced hypoglycemia, 0.l U/kg administered as an intravenous bolus, or levodopa, 500 mg administered orally. Deficiency of GH was defined as a peak GH response _< 10.0 Supported in part by the HANID Foundation (Dr. AvRuskin). Submitted for publication July 11, 1989; accepted Oct. 6, 1989. Reprint requests: Vijaya Prashd, MB, BS, Interfaith Medical Center, 1545 Atlantic Ave., Brooklyn, NY 11213. *Current address: Mount Sinai Medical Center, Box 1198, One Gustave L. Levy Place, New York, NY 10029. 9/22/17101
ng/ml, measured by double-antibody radioimmunoassay. Spontaneous GH secretion was evaluated by continuous blood withdrawal by pump, with collection of samples every 30 minutes for 24 hours. Deficient response was defined by this integrated concentration of GH of 2 SD for chronologic age, and growth rates were ~
