|The epiphyses of this young child are stippled. The differential for this is :|
Congenital skeletal dysplasias (Morquios, Trisomy 18/21, Multiple epiphyseal dysplasia (MED) and its local hip variant (Meyers))
Metabolic (hypothyroidism) Intrauterine exposures (TORCH infections, maternal warfarin (stippled dense bone too) or alcohol)
Zellwegers syndrome (cerebrohepatorenal disease-brain anomalies, renal cysts, liver failure –usually die by 1yr) Chondrodysplasia Punctata (recessive die very early, autosomal dominant variant Conradi-Hunerman syndrome, milder, asymmetric look for coronal vertebral clefts).
However, in this case the epiphyses are also immature for the skeleton of this child (approx. 6 years old).
So combine with the differential for retarded skeletal maturation:
Hypogonadism (Turner’s) Hypopituitarism (primary or secondary to craniopharyngioma)Hypothyroidism
Cushings and steroids
Severe constitutional disease (CHD, coeliac, crohns, chronic anaemias)