1. Slipped Capital Femoral Epiphysis Occurred in Patients over 20 Years - Two cases - Sung-Taek Jung Jin Choi Bong-Hyun Bae Yong-Uk Kim * Sung-Man Rowe Sung-Taek Jung Jin Choi Bong-Hyun Bae Yong-Uk Kim * Sung-Man Rowe Department of Orthopedics Chonnam National University Hospital, Department of Orthopedics Gwangju City Hospital *

2. Case 1 30 year-old, male C/C: Left hip pain & restriction of joint movement (minor trauma 7 days prior to visit)

3. P/H: Surgical removal of pituitary gland at 17 year-old d/t craniopharyngioma Residual tumor resection at 22 year-old Case 1 Chronologic Age: 30 year-old Bone Age: 13 year-old Height: 157 cm Weight: 40 Kg Small genitalia No pubic & axillary hair

4. Case 1 Radiographic findings (Preop)

5. Case 1 Endocrinologic lab. findings Hormone Patient Normal level T3 63 ng/dl 80-220 Free T4 0.14 ng/dl 0.7-2 LH 0.21 mIU/ml 10-25 FSH 0.01 mIU/ml 10-30 Growth H <0.1 ng/ml 1-5 Testosterone <0.01 ng/ml 1.88-8.96 Cortisol <0.1 ug/dl 3-23 Prolactin 6.59 ng/ml 0-25 Chromosomal study : 46, XY T3; triiodothyronine, T4; thyroxine, LH; luteinizing hormone, FHS; follicular stimulating hormone

6. Case 1 Radiographic findings (Postop)

7. Case 2 24 year-old, female C/C: Left hip pain & restriction of joint movement ( slip down 3 weeks prior to visit)

8. Chronologic Age: 24 year-old Bone Age: 12.6 year-old Height: 173 cm Weight: 55.8 Kg No closure of epiphyseal plates Brain MRI: Non-specific finding Case 2 P/H: Growth hormone therapy at 12 year-old d/t short stature

9. Amenorrhea Breast: Tanner stage I No pubic & axillary hair Sonography: 2 cm sized uterus & no ovary Case 2

10. Radiographic findings (Preop)

11. Case 2 Endocrinologic lab. findings Hormone Patient Normal level T3 123 ng/dl 80-220 T4 5.6 ng/dl 4.5-12.5 LH 0.01 mIU/ml 10-25 FSH 0.30 mIU/ml 10-30 Estradiol 20 pg/ml 30-120 Growth H <0.1 ng/ml 1-5 Cortisol 0.1 ug/dl 3-23 Prolactin 11.15 ng/ml 0-25 Chromosomal study : 46, XX T3; triiodothyronine, T4; thyroxine, LH; luteinizing hormone, FHS; follicular stimulating hormone

12. Case 2 Radiographic findings (Postop)

13. Discussion

14. - Zondek, 1936 - Rubinsten, 1939 - Ray et al, 1941 - Gardner et al, 1943 - Harris, 1950 - Chung, 1976 Endocrinopathy in SCFE Growth hormone (GH)  Proliferation of chondrocytes  Accelerated development of epiphysis  Weakened the support for the shear force Sex hormone (SH)  Suppress the proliferation of chondrocytes  Termination of growth of physeal plate

15. Absolute increase of GH Absolute decrease of SH Relative reduction of SH Thickness of physeal plate Weakened binding of epiphysis to metaphysis SCFESCFE

16. Hypothyroidism Hypogonadism Panhypopituitarism Growth hormone therapy Endocrinologicfactors Endocrinologic factors

17. Ratio of GH & SH Case I Patient Normal Growth H <0.1 ng/ml 1-5 Testosterone <0.01 ng/ml 1.88-8.96 Ratio (G/S) 10/1 1/8.9 ~ 2.7/1 Case II Growth H <0.1 ng/ml 1-5 Estradiol 20 pg/ml 30 -120 Ratio (G/S) 5/1 8.3/1 ~ 166.7/1 Growth hormone therapy history (+) SCFE in Hypopituitarism

18. Preop. & Postop. Management Preop. & Postop. Management : Glucocorticoids should be administered

19. Reported SCFE with hypopituitarism: Kim et al, 1988 Moorefield et al, 1976 Proper management : Preop. & Postop. Glucocorticoids Prophylactic pinning Incidence of pituitary tumor: 1.6~1.8 / 100,000 Discussion Points Be aware of Possibility of SCFE with hypopituitarism SCFE with hypopituitarism

20. Thank You for Your Kind Attention !