Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, N.S., Canada.
Horm Res Paediatr. 2013;80(1):64-8. doi: 10.1159/000351028. Epub 2013 Jul 13.
Obesity, age and hormone imbalances including hypothyroidism and growth hormone deficiency and therapy, but not gonadotropin-releasing hormone agonist (GnRHa) therapy, have been identified as risk factors for slipped capital femoral epiphysis (SCFE). Five of 7 reported cases describe SCFE in children shortly after GnRHa therapy cessation.
We report 3 cases of SCFE that occurred in children on GnRHa therapy for the treatment of central precocious puberty (CPP) and discuss possible promoting factors.
An otherwise healthy 8.75-year-old girl [body mass index (BMI) Z score +1.75] developed SCFE 6.75 years into GnRHa therapy for idiopathic CPP. A second girl (with a history of acute lymphoblastic leukemia requiring total body irradiation) was 10.6 years old (BMI Z score +1.06) when she developed SCFE 3.3 years into GnRHa therapy. The third case was an 8.75-year-old female with CPP secondary to a hypothalamic hamartoma (BMI Z score +1.65) who developed bilateral SCFE 5.6 years into therapy.
Increasing evidence suggests an association between GnRHa therapy for CPP and the occurrence of SCFE. We suggest that a lack of adequate sex hormone exposure at a 'critical period' of bone formation may result in a weakened epiphysis that becomes susceptible to slipping. © 2013 S. Karger AG, Basel.
肥胖、年龄和激素失衡（包括甲状腺功能减退症和生长激素缺乏症以及治疗），但不包括促性腺激素释放激素激动剂（GnRHa）治疗，已被确定为股骨头骨骺滑脱（SCFE）的危险因素。在报告的 7 例病例中，有 5 例描述了 GnRHa 治疗停止后不久儿童发生的 SCFE。
我们报告了 3 例接受 GnRHa 治疗特发性中枢性性早熟（CPP）的儿童发生 SCFE 的病例，并讨论了可能的促进因素。
一名 8.75 岁的健康女孩[体重指数（BMI）Z 评分+1.75]在接受 GnRHa 治疗 CPP 6.75 年后发生了 SCFE。第二位女孩（因急性淋巴细胞白血病需要全身放疗）在接受 GnRHa 治疗 3.3 年后，10.6 岁（BMI Z 评分+1.06）时发生了 SCFE。第三位病例是一名 8.75 岁的女性，因下丘脑错构瘤（BMI Z 评分+1.65）引起 CPP，在接受治疗 5.6 年后双侧发生 SCFE。
越来越多的证据表明，CPP 的 GnRHa 治疗与 SCFE 的发生之间存在关联。我们认为，在骨形成的“关键期”缺乏足够的性激素暴露可能导致骨骺变弱，从而容易发生滑脱。© 2013 S. Karger AG，巴塞尔。
