Slipped Capital Femoral Epiphysis Associated with Hyperparathyroidism: A Case Report

Area of Science:

• Endocrinology
• Pediatric Orthopedics
• Metabolic Bone Disease

Background:

• Slipped capital femoral epiphyses (SCFEs) typically present in early adolescence and are associated with obesity.
• Atypical SCFE presentations, such as late pubertal onset, nephrolithiasis, and normal BMI, warrant further investigation.
• Primary hyperparathyroidism is a rare endocrine disorder characterized by excessive parathyroid hormone production, leading to hypercalcemia.

Purpose of the Study:

• To report a case of primary hyperparathyroidism presenting atypically with SCFE in a 15-year-old male.
• To emphasize the importance of metabolic evaluation in patients with SCFE and unusual clinical features.
• To highlight the successful management of hypercalcemia and SCFE through a multidisciplinary approach.

Main Methods:

• A 15-year-old male presented with symptoms suggestive of SCFE.
• Atypical clinical findings, including late presentation and nephrolithiasis, prompted a metabolic workup.
• Diagnosis of primary hyperparathyroidism due to a parathyroid adenoma was confirmed, and hypercalcemia was managed medically prior to surgical intervention for both conditions.

Main Results:

• The patient was diagnosed with primary hyperparathyroidism secondary to a parathyroid adenoma, causing significant hypercalcemia.
• Medical management of hypercalcemia included hydration, calcitonin, pamidronate, and cinacalcet.
• Subsequent parathyroidectomy and SCFE surgery resulted in normalized calcium levels and successful treatment of SCFE.

Conclusions:

• This case underscores the necessity of considering endocrine abnormalities, such as primary hyperparathyroidism, in the differential diagnosis of atypical SCFE.
• Early identification and management of metabolic derangements are crucial for optimizing treatment outcomes and preventing long-term complications in pediatric patients.
• A comprehensive approach involving endocrinologists and orthopedic surgeons is vital for managing complex cases involving both endocrine and orthopedic conditions.