Short stature as a screening test for endocrinopathy in slipped capital femoral epiphysis

Slipped capital femoral epiphysis may be associated with hypothyroidism and other endocrinopathies, Routine screening for such abnormalities is unlike ly to be cost-effective since the overall incidence of these disorders, in association with slipped capital femoral epiphysis, is low, The identificat ion of a presenting characteristic which would predict the chance of an ass ociated endocrinopathy would allow only selected children to be screened, Our aim was to determine if certain characteristics were useful as a screen for patients with an underlying endocrinopathy who presented with slipped capital femoral epiphysis, Between January 1988 and December 1996 we record ed gender, age, height, unilateral or bilateral involvement and an associat ed diagnosis of endocrinopathy for all patients who were treated for slippe d capital femoral epiphysis, Of 166 such patients 13 (7.8%) had an endocrin opathy, Height was the only useful screening characteristic, although bilat eral involvement was more likely in those with an endocrinopathy, Most (90. 9%) of this latter group were below the tenth percentile for height compare d with only 5.4% in those who did not have an endocrinopathy (p < 0.005). T he sensitivity and negative predictive value of detecting an underlying end ocrinopathy in a patient presenting with a slipped capital femoral epiphysi s and short stature (tenth percentile or less) were 90.2% and 98.6%, respec tively. Patients who are on or below the tenth percentile for height at the time of presentation should be screened for a possible endocrine abnormality using measurement of thyroid-stimulating hormone and free thyroxine as a prelimi nary screening test, These hormones are most likely to be abnormal in the p resence of endocrine dysfunction.