Orthopedic complications related to growth hormone therapy in a pediatric population.

Since the introduction of recombinant growth hormone, its use has diversified and multiplied. Growth hormone is now the recommended therapy for a growing indication to all forms of short stature because of its direct and indirect role on bone growth. Hereby, we discuss the orthopedic complications associated with growth hormone treatment in pediatric patients. These complications include carpal tunnel syndrome, Legg-Calve-Perthes' disease, scoliosis, and slipped capital femoral epiphysis. Their incidence rates recorded in several growth hormone therapy-related pharmacovigilance studies will be summarized in this study with focused discussion on their occurrence in the pediatric and adolescent age groups. The pathogenesis of these complications is also reviewed.

A case of frequently relapsing nephrotic syndrome combined with Perthes disease.

Orally-administered steroids often induce osteonecrosis of the femoral head. In cases of Perthes disease, osteonecrosis of the femoral head occurs in children due to an unknown cause. Our subject was a 4-year-old boy who had to be given large amounts of steroids because of frequently relapsing nephrotic syndrome (FRNS) developed after the onset of Perthes disease. One month earlier, he would limp with his right leg, but his radiographs were normal. Later, facial edema appeared and he was brought to our hospital with heavy proteinuria. He was diagnosed with NS and prescribed prednisolone for 2 months. As he would limp occasionally during the treatment, he had an orthopedic examination at our hospital, and shrinkage of the right femoral head was disclosed. Perthes disease was diagnosed on the basis of his MRI and clinical history. Meanwhile, NS relapsed twice over a half year, and he was diagnosed as having FRNS. Cyclophosphamide was administered for 12 weeks. Four years later, MRI indicated that the femoral head slowly improved and he was able to walk without prosthetic support. These results suggest that in the course of healing from Perthes disease, the conventional method of using prednisolone has little impact on the femoral head.

Orthopaedic concerns in children with growth hormone therapy.

Growth hormone (GH) therapy is widely used in children; it may have various severe orthopaedic complications. Slipped capital femoral epiphysis, Legg-Calvé-Perthes disease, scoliosis and carpal tunnel syndrome may occur with GH treatment. Before beginning GH therapy, it is important to take into account all the risk factors of the individual patient, as some conditions could contraindicate GH treatment. During GH treatment, close monitoring with both clinical and radiographic examination is mandatory. The paediatric orthopaedic surgeon will frequently be asked about the management of these complications and about the necessity for treatment arrest. The authors review the orthopaedic complications which the orthopaedic surgeon may encounter in patients treated with GH.

Avascular necrosis of the femoral head following heart transplant in a child.

A case of avascular necrosis of the femoral head following heart transplantation in a 2-year-old child has been followed to skeletal maturity. Avascular necrosis is a well-known complication following steroid use in childhood. There are no reported cases of avascular necrosis following heart transplant in childhood. Similar cases should be reported.

[Perthes disease after successfully treated acute juvenile lymphoblastic leukemia]. / Morbus Perthes nach erfolgreich behandelter akuter Lymphoblasten-Leukämie im Kindesalter.

The manifestation of Perthes disease after succesfully treated lymphoblastic leukemia is extremely rare. At the first signs of a femoral head necrosis--sonsidering the basic disease--and after cortisone treatment one has to think of a possible femoral head necrosis. It has been observed by several authors after long-term cortison therapy. The case of a 7 year old boy with Perthes disease after acute lymphatic leukemia is demonstrated. After treatment with chemotherapy, cortisone and radiation of the head he was free of pain for 2 years, then the Perthes disease became manifest with a deformed femural head. It could be cured but operation is necessary now or at the latest after termination of growth. In the case there seems to be no connexion between cortisone treatment and the manifestation of Perthes disease. It is more probable that this developed independently of the basic disease and its successful treatment because of the unilateral affection of the hip joint and the interval between treatment of leukemia and manifestion of the first symptoms of Perthes disease.