A short boy with a limp
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《印度儿科学杂志》
How to cite this article:
Singh R, Sriram M, Bhadada S, Bhansali A. A short boy with a limp. Indian J Pediatr 2006;73:541-541
How to cite this URL:
Singh R, Sriram M, Bhadada S, Bhansali A. A short boy with a limp. Indian J Pediatr [serial online] 2006 [cited 2006 Jul 14];73:541-541. Available from: http://www.ijppediatricsindia.org/article.asp?issn=0019-5456;year=2006;volume=73;issue=6;spage=541;epage=541;aulast=Singh
A 14-year-old boy presented with short stature and limping gait. On examination, his height was less than the 3rd centile and had a sexual maturity score of A 1 P 2 with testicular volume of 3 ml bilaterally (Tanner-White House). He had a regular pulse rate of 76/min, BP 110/70 mmHg, dry skin and no goiter. Neurological examination was unremarkable except for delayed relaxation of deep tendon reflexes. Bone age as assessed by Greulich-Pyle chart was 9 years. Serum biochemistry including calcium profile was normal. Thyroid profile showed T 3 0.50 ng/ml (N 0.6-1.3), T 4 56 ng/ml (N 60-120) and TSH 28.6 IU/ml
(N 0.5-5.5) typical of primary hypothyroidism. On 99m Tc thyroid scan, patient had a lingual thyroid [Figure - 1]. X-ray of the pelvis including upper one third of both femora showed irre-gular and fragmented femoral heads ("stippled appearance") characteristic of epiphyseal dysgenesis .
Discussion
The characteristic radiological picture is due to irregular and disordered fusion of islands of slowly maturing epiphyseal foci. In this age group the other differential diagnosis to be considered in a child presenting with a limp are avascular necrosis of the femoral heads, Perthe's disease (osteochondritis of the femoral head) and slipped capital femoral epiphyses with secondary osteoarthritic changes. The index patient improved gradually with levothyroxine replacement therapy (100 μg/day). Thyroid function tests done after 3 months showed normal profile. At one year of follow up, X-ray pelvis showed epiphyseal coalescement and formation suggestive of reversibility of disease(Singh Ramanbir, Sriram M,)
Singh R, Sriram M, Bhadada S, Bhansali A. A short boy with a limp. Indian J Pediatr 2006;73:541-541
How to cite this URL:
Singh R, Sriram M, Bhadada S, Bhansali A. A short boy with a limp. Indian J Pediatr [serial online] 2006 [cited 2006 Jul 14];73:541-541. Available from: http://www.ijppediatricsindia.org/article.asp?issn=0019-5456;year=2006;volume=73;issue=6;spage=541;epage=541;aulast=Singh
A 14-year-old boy presented with short stature and limping gait. On examination, his height was less than the 3rd centile and had a sexual maturity score of A 1 P 2 with testicular volume of 3 ml bilaterally (Tanner-White House). He had a regular pulse rate of 76/min, BP 110/70 mmHg, dry skin and no goiter. Neurological examination was unremarkable except for delayed relaxation of deep tendon reflexes. Bone age as assessed by Greulich-Pyle chart was 9 years. Serum biochemistry including calcium profile was normal. Thyroid profile showed T 3 0.50 ng/ml (N 0.6-1.3), T 4 56 ng/ml (N 60-120) and TSH 28.6 IU/ml
(N 0.5-5.5) typical of primary hypothyroidism. On 99m Tc thyroid scan, patient had a lingual thyroid [Figure - 1]. X-ray of the pelvis including upper one third of both femora showed irre-gular and fragmented femoral heads ("stippled appearance") characteristic of epiphyseal dysgenesis .
Discussion
The characteristic radiological picture is due to irregular and disordered fusion of islands of slowly maturing epiphyseal foci. In this age group the other differential diagnosis to be considered in a child presenting with a limp are avascular necrosis of the femoral heads, Perthe's disease (osteochondritis of the femoral head) and slipped capital femoral epiphyses with secondary osteoarthritic changes. The index patient improved gradually with levothyroxine replacement therapy (100 μg/day). Thyroid function tests done after 3 months showed normal profile. At one year of follow up, X-ray pelvis showed epiphyseal coalescement and formation suggestive of reversibility of disease(Singh Ramanbir, Sriram M,)