Peripheral precocious puberty secondary to severe hypothyroidism

Van Wyk-Grumbach syndrome is a rare form of severe hypothyroidism. We present a 10.9-year-old girl who consulted for genital bleeding, Tanner stage 2, and clinical manifestations of hypothyroidism. Severe hypothyroidism was confirmed, secondary to chronic lymphocytic thyroiditis. A pelvic ultrasound showed bilateral evidence of cystic ovarian masses. The hormonal profile confirmed peripheral precocious puberty secondary to hypothyroidism. A pituitary MRI showed significant pituitary elongation due to thyrotropic hyperplasia. After initiating treatment with thyroid hormone, there was a notable clinical improvement and resolution of the adnexal masses and pituitary hyperplasia. The pediatrician must be able to identify signs and symptoms associated with thyroid dysfunction and prompt referral to a pediatric endocrinologist to avoid the appearance of severe conditions such as the one presented.