title: Approach to the management of slipped capital femoral epiphysis and primary hyperparathyroidism.
abstract: BACKGROUND
  Worldwide, only nine cases of revealing slipped capital femoral epiphysis (SCFE) associated with primary hyperparathyroidism (PHP) have been reported.
  
  
  METHODS
  This study included adolescent subjects with the described association, the clinical course, and exhibiting the leading pathogeneses.
  
  
  METHODS
  Here, we reviewed all known cases and developed an effective approach to the management of SCFE and PHP.
  
  
  RESULTS
  In cases of emergency, SCFE fixation is primarily done regardless of any preexistent hypercalcemia due to PHP and followed by parathyroidectomy as soon as possible. In cases of mild and moderate hypercalcemia, whether SCFE fixation is followed by parathyroidectomy and vice versa or resolved during a single operating session depends on manifest side effects due to hyercalcemia. Patients with severe hypercalcema should undergo urgent parathyroidectomy, followed by immediate orthopedic surgery, even as a simultaneous procedure. This is to avoid onset of hypercalcemic side effects or worsening of preexisting side manifestations resulting from hypercalcemia.
  
  
  CONCLUSIONS
  Our report demonstrates that SCFE presenting with hypercalcemia, with signs of low bone density, or in atypical age deserves further workup for secondary causes. In addition, the newly developed systematic approach toward achieving an effective, efficient management should help to improve the patients' long-term outcome.
authors.affiliation: Department of Pediatric Cardiology and Pulmonology, Medical Faculty, University of Duesseldorf, Duesseldorf, Germany. tarik.elscheich@med.uni-duesseldorf.de
authors.forename: Tarik
authors.initials: T
authors.lastname: El Scheich
authors.forename: Jan
authors.initials: J
authors.lastname: Marquard
authors.forename: Bettina
authors.initials: B
authors.lastname: Westhoff
authors.forename: Rüdiger
authors.initials: R
authors.lastname: Krauspe
authors.forename: Axel
authors.initials: A
authors.lastname: Schneider
authors.forename: Kenko
authors.initials: K
authors.lastname: Cupisti
authors.forename: Jun
authors.initials: J
authors.lastname: Oh
authors.forename: Thomas
authors.initials: T
authors.lastname: Meissner
authors.forename: Ertan
authors.initials: E
authors.lastname: Mayatepek
authors.forename: Dirk
authors.initials: D
authors.lastname: Klee
mesh_terms: D000293:Adolescent; D000465:Algorithms; D006801:Humans; D049950:Hyperparathyroidism, Primary / Q000150:complications* / Q000601:surgery*; D008297:Male; D016105:Parathyroidectomy; D011859:Radiography; D060048:Slipped Capital Femoral Epiphyses / Q000000981:diagnostic imaging / Q000209:etiology*