Kempers M J, Noordam C, Rouwé C W, Otten B J
Department of Paediatric Endocrinology, University Hospital of Amsterdam, The Netherlands.
J Pediatr Endocrinol Metab. 2001 Jun;14(6):729-34. doi: 10.1515/jpem.2001.14.6.729.
Slipped capital femoral epiphysis (SCFE) mainly occurs in pubertal children and is associated with delayed skeletal maturation, obesity, high growth velocity and tall stature. Furthermore, SCFE often coincides with endocrine disorders. This is the first report of a possible relationship between SCFE and GnRH agonist treatment: four patients developed SCFE during or shortly after treatment with GnRH agonists was stopped. We compared the clinical aspects of these patients with patients described in the literature who developed SCFE. Puberty started at the age of 3.3, 9.6, 0.0 and 5.6 years respectively. One patient developed sequential SCFE of both hips. SCFE occurred at the age of 11.9 (patient 1), 12.7 (patient 2), 14.3 (patient 2), 11.3 (patient 3) and 11.3 (patient 4) years. Of the five incidences of SCFE, one occurred during GnRH agonist treatment and four shortly after treatment was stopped. None of our patients met the typical criteria seen in SCFE and no 'regular' characteristics of patients with SCFE could be designated. Probably the hormonal changes during and shortly after treatment with GnRH agonists make the epiphysis more prone to slip. Considering our observations and by reviewing the literature, GnRH agonist treatment might present a risk factor for the occurrence of SCFE.
股骨头骨骺滑脱（SCFE）主要发生于青春期儿童，与骨骼成熟延迟、肥胖、生长速度快及身材高大有关。此外，SCFE常与内分泌紊乱同时出现。本文首次报道了SCFE与促性腺激素释放激素（GnRH）激动剂治疗之间可能存在的关系：4例患者在GnRH激动剂治疗期间或停药后不久发生了SCFE。我们将这些患者的临床情况与文献中报道的发生SCFE的患者进行了比较。青春期开始的年龄分别为3.3岁、9.6岁、0.0岁和5.6岁。1例患者双侧髋关节先后发生SCFE。SCFE发生的年龄分别为11.9岁（患者1）、12.7岁（患者2）、14.3岁（患者2）、11.3岁（患者3）和11.3岁（患者4）。在这5例SCFE中，1例发生在GnRH激动剂治疗期间，4例在停药后不久发生。我们的患者均不符合SCFE的典型标准，也无法确定SCFE患者的“常规”特征。GnRH激动剂治疗期间及治疗后不久的激素变化可能使骨骺更容易发生滑脱。基于我们的观察并通过文献回顾，GnRH激动剂治疗可能是SCFE发生的一个危险因素。
