Slipped Capital Femoral Epiphysis Associated with Primary Hyperparathyroidism and Severe Hypercalcemia

A 13-year-old female, who has been previously healthy, fell down while roller blading. Several months later, she experienced bilateral hip pain on walking and developed a waddling gait. She was first seen by an orthopedic surgeon who diagnosed bilateral slipped epiphyses of femoral heads (Figure 1). The patient underwent bilateral in situ pinning and was immobilized in bed for a period of 3 months. Her preoperative work-up was significant for mild hypercalcemia; calcium, 2.78 mmol/L (normal range: 2.2-2.6 mmol/L); and high alkaline phosphatase, 1,780 units/L (normal range: 50-136 units/L). This hypercalcemia was not appreciated by the orthopedic surgeons and was never fully investigated before surgery. Moreover, her surgeons discharged the immobilized patient on a regimen of vitamin D supplements in the form of 1-alphacholecalciferol: 2.5 mcg/day. Three weeks after surgery the patient was referred to our en-