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Congenital growth hormone deficiency associated with hip dysplasia and Legg-Calve-Perthes disease
Elisa B Lamback1, Stella Chiarini1, Andreas Roposch1
1Great Ormond Street Hospital for Children, London, UK.
Insights
Congenital Growth Hormone Deficiency (GHD) may cause hip dysplasia. Recombinant human Growth Hormone (rhGH) treatment is unlikely to cause Legg-Calve-Perthes disease (LCPD).
Area of Science:
- Pediatric Endocrinology
- Orthopedics
Background:
- Growth Hormone Deficiency (GHD) is typically managed with recombinant human Growth Hormone (rhGH).
- Hip disorders, including hip dysplasia and Legg-Calve-Perthes disease (LCPD), have rarely been linked to GHD or its treatment.
Purpose of the Study:
- To investigate the association between congenital GHD, hip dysplasia, and LCPD.
- To determine if hip disorders in GHD patients are related to the underlying condition or rhGH therapy.
Main Methods:
- Retrospective analysis of pediatric and adolescent patients with congenital GHD and hip disorders (1992-2018).
- Data collection included demographics, clinical and imaging findings, and treatment timelines.
Main Results:
- Of 13 patients, 10 had hip dysplasia and 3 had LCPD.
- Hip dysplasia was diagnosed before rhGH initiation in 50% of cases.
- LCPD progression was not consistently linked to rhGH treatment initiation.
Conclusions:
- Hip dysplasia may be a manifestation of congenital GHD itself.
- rhGH treatment is unlikely to be the primary cause of LCPD in patients with GHD.
Objective:
Growth hormone deficiency (GHD) is usually treated with recombinant human GH (rhGH), and this has been rarely associated with hip disorders. We analysed the clinical data of patients with congenital GHD receiving rhGH who had associated hip dysplasia or Legg-Calve-Perthes disease (LCPD), with a view to determining whether the hip dysplasia was associated with the underlying disease or with rhGH treatment.
Design:
We performed a retrospective analysis of paediatric and adolescent patients seen between 1992-2018 with congenital GHD and hip disorders. Data were collected through a review of the patients' medical records and included demographics, clinical and imaging data, and the time frame between the onset of the symptoms related to the hip disorders and the onset of GH treatment.
Results:
Of the 13 patients with hip disorders, hip dysplasia was present in ten patients and LCPD in three. Hip dysplasia was diagnosed before rhGH was initiated in 50% of cases. These patients had bilateral hip dysplasia and isolated GHD. LCPD was diagnosed in one patient before rhGH was commenced and did not progress. In two patients, LCPD was diagnosed after rhGH was started and did temporarily progress in one of them, but rhGH was not discontinued because LCPD did not seem to be related to rhGH treatment.
Conclusions:
This study suggests that hip dysplasia could be a manifestation of an underlying GHD. Additionally, rhGH treatment may not necessarily be causative of LCPD.
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