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JAMA Pediatrics Clinical Challenge
March 2017

Teenager With Hip Pain and Limp

Author Affiliations
  • 1Division of Pediatric Endocrinology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
  • 2Division of Hospital Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
JAMA Pediatr. 2017;171(3):297-298. doi:10.1001/jamapediatrics.2016.3162

A 13-year-old girl presented to an emergency department with bilateral hip pain for several months and acute worsening with left-sided limp following a school field trip to a large museum. She stated that her pain worsened with walking and was minimally relieved with salicylic acid. Her parents tried to schedule an outpatient appointment for evaluation of her hip pain but had difficulty owing to a lack of a primary care physician. Review of systems was significant for heavy periods since menarche 6 months ago. It was negative for easy bruising or bleeding. The patient described normal stooling and voiding habits. The patient was described as a shy eighth grader who earns A’s and B’s in school. She was not physically active. On physical examination, the patient was noted to be short for her age (1.3 m [4.4 ft]; height in <third percentile), weight (62.5 kg; 87th percentile), and body mass index (35 [calculated as weight in kilograms divided by height in meters squared]; 99th percentile). She had a relatively short, thick neck with acanthosis nigricans, dry skin, Tanner stage II breasts, and nonpitting edema of her hands (Figure 1A). Her family history was significant for hypothyroidism and coronary artery disease in the father, type 2 diabetes mellitus in the maternal great grandmother, and hypothyroidism in the maternal grandmother. Radiography of the hips was performed (Figure 1B), showing bilateral slipped capital femoral epiphysis (SCFE). Prior to undertaking definitive surgical correction of the hips, it is important to consider the potential underlying condition.

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