Abstract
Two patients with hypopituitarism complicated with slipped femoral epiphysis presented for treatment. The heights of both men (22 and 30 years old) continued to increase in adulthood despite low levels of growth hormone and somatomedin.
In order to close the systemic epiphyseal line, hormone replacement therapy was performed with T4 (75μg per day) orally, adrenocortical hormones (20mg per day) orally, and testosterone (250mg once per two weeks) intramuscularly. Moreover, to prevent slipping and thus to close the epiphyseal line, the slipped femoral epiphysis was pinned in situ using canulated cancellous hip screws.
Radiographic images of patient 1 showed that the proximal epiphyseal line of the femoral head had become closed after a year of treatment, and the hip screws were removed. His rate of increase in height has been reduced to 0.4mm per year. In patient 2, we found partial closure of the proximal epiphyseal line of the femoral epiphysis after 4 months of treatment, and this patient is under observation. Both patients were free of hip pain with no further worsening of the slipping.
Based on our experience of these two patients, we speculate that certain endocrines with growth hormone-like action (for example, insulin) are involved in incomplete closure of the epiphyseal line and continued growth.
