Stippled Epiphyses Differential Diagnosis

Today's Daily Diff is about stippled epiphyses. In these cases, the epiphyses appear to have multiple, small, round densities within them. If you have a hard time remembering the diverse causes, don't worry - just take a WHACK at it:

	Disease	Notes
W	Warfarin	maternal use during pregnancy
H	Hypothyroidism Hans Zellweger syndrome	Hypothyroidism / cretinism is a much more common cause Hans Zellweger aka cerebro-hepato-renal syndrome rare leukodystrophy punctata in patella
A	Alcohol	maternal use during pregnancy
C	Chondrodysplasia punctata congenita	multiple variants exist (ex: Conradi–Hünermann syndrome) causes growth problems
K	vitamin K deficiencies	Vitamin K reductase deficiency ex: Warfarin use

Admittedly, the mnemonic is a bit of a stretch, but essentially the diagnoses are either due to syndromes or factors that affect vitamin K metabolism.