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[Lesions of the hip in congenital myxedema in children]
Insights
Congenital hypothyroidism in children can cause hip abnormalities, but early screening and treatment significantly improve outcomes. Prompt therapy helps prevent long-term skeletal complications, particularly in the hip joint.
Area of Science:
- Pediatric Endocrinology
- Pediatric Orthopedics
- Developmental Biology
Background:
- Congenital hypothyroidism (CH) can affect bone development, including the hip.
- Radiographic findings in CH hips can mimic other conditions like Legg-Calvé-Perthes disease.
- Understanding normal hip development is crucial for identifying CH-related abnormalities.
Purpose of the Study:
- To analyze hip lesions in 51 children with congenital hypothyroidism.
- To review normal hip development and the role of thyroid hormones.
- To differentiate CH-related hip changes from other pediatric hip conditions.
Main Methods:
- Analysis of 51 cases of congenital hypothyroidism.
- Review of epiphyseal and articular cartilage growth mechanisms.
- Discussion of thyroid hormone effects on bone growth and maturation.
- Radiographic assessment of hip abnormalities in affected children.
Main Results:
- Radiographic findings in CH hips include delayed ossification ('joint emptiness') and 'pseudo-fragmentations'.
- These changes are often functional despite concerning radiographic appearance.
- CH hip abnormalities typically adapt well to the acetabulum, with low risk of severe deformity.
- Legg-Calvé-Perthes disease can be excluded based on clinical and radiographic findings.
Conclusions:
- Early diagnosis of CH through neonatal screening is vital.
- Prompt thyroid hormone replacement therapy can prevent or mitigate skeletal complications.
- Skeletal abnormalities, particularly hip lesions, are often reversible with timely intervention.
Abstract:
A series of 51 cases of congenital myxoedemia in children was analyzed to determine incidence of associated hip lesions. Mechanisms of epiphysial and articular cartilage growth are reviewed and events summarized that occur normally in the "growing hip": the upper femoral nucleus, and orientations of femoral neck and their physiologic variations. The role of thyroid hormones in bone growth is also discussed. Reviewed in greater detail are the myxedematous hips in children, or epiphysial dysgenesis, the causes of delay in bone maturation, the effect of substitutive therapy and mineralization disorders. In contrast to the richness of radiographic data, often very disturbing, restriction or even absence of functional signs is almost a constant feature, enabling a diagnosis of Legg-Perthes-Calvet's disease to be rejected, certain radiologic images being considered wrongly as comparable. Radiography provides images varying from delayed ossification of a sometimes very long upper femoral nucleus, termed "joint emptiness", to "pseudo-fragmentations" that are frequently encountered and are actually progressive ossifications. These sometimes progress towards deformity of femoral head in coxa plana but are usually well adapted to the acetabulum, reducing initial fears. Different parameters studied in the 51 patients are analyzed and an optimistic conclusion given, since neonatal screening for congenital myxedema and subsequent therapy should eliminate skeletal complications, particularly in the hip.