Endocrinologic and metabolic factors in atypical presentations of slipped capital femoral epiphysis. Report of four cases and review of the literature.

Although the usual etiology of slipped capital femoral epiphysis (SCFE) is idiopathic, there are many underlying endocrinologic, biomechanical, metabolic, and connective tissue abnormalities that increase the predisposition to slippage. Four case reports and a review of the literature demonstrate tht hypopituitarism, renal rickets, radiation therapy, hypoestrogenic states, and chemotherapy can be associated with SCFE. Awareness of the variety of conditions under which SCFE can occur is an important factor in providing early diagnosis, since many patients undergo slippage at atypical ages. In metabolically and endocrinologically abnormal patients, surgical stabilization may need to be augmented by autologous bone grafting to ensure successful epiphyseodesis.