Peripheral precocious puberty secondary to severe hypothyroidism.

Area of Science:

• Pediatric Endocrinology
• Reproductive Endocrinology
• Thyroidology

Background:

• Van Wyk-Grumbach syndrome is a rare clinical manifestation of severe primary hypothyroidism.
• It is characterized by signs of hypothyroidism along with signs of estrogenization, including precocious pseudopuberty.

Observation:

• A 10.9-year-old girl presented with genital bleeding and clinical signs of hypothyroidism.
• Pelvic ultrasound revealed bilateral cystic ovarian masses, and hormonal profiles indicated peripheral precocious puberty secondary to hypothyroidism.
• Pituitary MRI demonstrated significant pituitary elongation due to thyrotropic hyperplasia.

Findings:

• Severe hypothyroidism secondary to chronic lymphocytic thyroiditis was confirmed.
• Treatment with thyroid hormone led to clinical improvement, resolution of adnexal masses, and normalization of pituitary hyperplasia.

Implications:

• This case highlights the importance of recognizing thyroid dysfunction in pediatric patients presenting with unusual symptoms.
• Early diagnosis and prompt referral to pediatric endocrinology are crucial for managing severe hypothyroidism and its associated complications.
• Pediatricians should be vigilant for signs of thyroid dysfunction to prevent severe outcomes like Van Wyk-Grumbach syndrome.