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Pediatric Psoriasis Associated with Van Wyk Grumbach Syndrome: A case report
Asma Marzouk1, Rania Mezzi1, Saida Zelfani1
1Pediatrics and Neonatology department, Yasminet Ben Arous, Tunisia. University El Manar, Faculty of Medicine of Tunis.
Insights
Pediatric psoriasis patients require thyroid function assessment. Early hypothyroidism treatment can manage Van Wyk Grumbach syndrome symptoms and improve growth outcomes.
Area of Science:
- Pediatric Endocrinology
- Dermatology
- Endocrinology
Background:
- Psoriasis is a chronic inflammatory condition common in children, associated with autoimmune disorders.
- Co-occurrence of psoriasis with Van Wyk Grumbach syndrome (hypothyroidism, early puberty, ovarian cysts) is rare in pediatrics.
- Van Wyk Grumbach syndrome presents with precocious puberty and ovarian pathology due to untreated hypothyroidism.
Observation:
- A 15-year-old female with psoriasis since age 9 presented with constipation, headaches, and early puberty (menarche at 9).
- Clinical findings included growth retardation and hypertension; hormonal analysis confirmed primary hypothyroidism (FT4=7 pmol/mL, TSH=200 mIU/mL).
- Pelvic pain and menstrual irregularities led to the discovery of an ovarian cyst, confirming Van Wyk Grumbach syndrome.
Findings:
- The patient was diagnosed with Van Wyk Grumbach syndrome, characterized by early puberty, hypothyroidism, and polycystic ovaries.
- Treatment with l-thyroxine stabilized blood pressure and hormonal levels.
- Despite treatment, the patient's height remained below the target adult height.
Implications:
- Screening for thyroid dysfunction is crucial in pediatric psoriasis patients.
- Timely hormonal replacement therapy for hypothyroidism can mitigate Van Wyk Grumbach syndrome symptoms.
- Early intervention may improve long-term growth outcomes in affected children.
Introduction:
Psoriasis is a common chronic inflammatory condition, often beginning in childhood in approximately one-third of cases. It can be associated with various other autoimmune diseases such as rheumatoid arthritis, celiac disease, and thyroid disorders. However, its co-occurrence with Van Wyk Grumbach syndrome has not been described in the pediatric population. This syndrome, resulting from untreated hypothyroidism, is characterized by early puberty and ovarian cysts.
Observation:
A 15-year-old adolescent with a diagnosis of psoriasis since the age of 9 presented with chronic constipation and headaches. She exhibited early puberty (menarche at 9 years) and academic regression. Clinical examination revealed growth retardation and arterial hypertension. Hormonal analyses revealed primary hypothyroidism : Free Thyroxine (FT4)=7pmol/mL(9- 20 pmol/l), Thyroid Stimulating Hormone (TSH)=200 mIU/mL( 0,4 - 5 mUI/ml.). The ultrasound and scintigraphic appearance were suggestive of thyroiditis. Additionally, she experienced menstrual irregularities and pelvic pain. Radiological exploration revealed a left ovarian cyst. The diagnosis of Van Wyk Grumbach syndrome was established due to early puberty, hypothyroidism, and polycystic ovary. Treatment with l-thyroxine led to stabilization of blood pressure and hormonal levels. Her height remained below the target adult height.
Conclusion:
Assessment of thyroid function appears necessary in pediatric patients with psoriasis. Early hormonal replacement therapy for hypothyroidism may alleviate the symptoms of Van Wyk Grumbach syndrome and mitigate its impact on stature.
