title: Occurrence of slipped capital femoral epiphysis in children undergoing gonadotropin-releasing hormone agonist therapy for the treatment of central precocious puberty.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatrics, IWK Health Centre, Dalhousie University, Halifax, N.S., Canada.
authors.forename: Mark
authors.initials: M
authors.lastname: Inman
authors.forename: Brenden E
authors.initials: BE
authors.lastname: Hursh
authors.forename: Arati
authors.initials: A
authors.lastname: Mokashi
authors.forename: Teresa
authors.initials: T
authors.lastname: Pinto
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Metzger
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Cummings
mesh_terms: D000365:Age Determination by Skeleton; D002648:Child; D002675:Child, Preschool; D005260:Female; D007987:Gonadotropin-Releasing Hormone / Q000819:agonists*; D006222:Hamartoma; D006801:Humans; D007027:Hypothalamic Diseases; D007223:Infant; D016729:Leuprolide / Q000009:adverse effects*; D050177:Overweight / Q000150:complications; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000532:radiotherapy; D011629:Puberty, Precocious / Q000188:drug therapy*; D060048:Slipped Capital Femoral Epiphyses / Q000139:chemically induced* / Q000601:surgery
chemical_list: D007987:Gonadotropin-Releasing Hormone; D016729:Leuprolide