PMC2814228_01
PMC2814228_02
Growth chart depicts the patient's growth at diagnosis and over the course of follow up on growth hormone therapy.
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fig1
She did not have any regular well child care until this illness.  She was born full term with birth weight of 8 lbs and her early development was described as normal.  She was home schooled because of some learning difficulties.  Her mid-parental height was 167.6 cm which is at 75th percentile (+0.67 SD).  On physical exam, the patient was 158.1 cm tall (25th%) (Figure 1), and weighed 65 kg (75th%).  Her body mass index was 26 kg/m2 (90th%).  She had bilateral hip pain with hips held in obligatory external rotation.  Hip flexion was limited to 60 degrees bilaterally. She had waddling gait and pain with walking.  She had Tanner stage 1 for breast and pubic hair development.  
An anteroposterior radiograph of the pelvis revealing severe, bilateral, valgus slipped capital femoral epiphysis.
IJPE2009-609131.002.jpg
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fig2
An anteroposterior pelvis radiograph (Figure 2) showed bilateral, chronic, severe, valgus SCFE, confirmed with CT scan.  She was admitted to Orthopedic service for hip surgery.  Endocrine service was consulted due to her delayed puberty and primary amenorrhea.  Laboratory studies showed low free