Isosexual precocious puberty with primary hypothyroidism: an interesting case report
Keywords:Abdominal mass, Hypothyroidism, Precocious puberty
Isosexual precocious puberty in a girl child is defined as thelarche before 6 years in African–Americans and 7 years in Caucasians and menarche before the age of 9 years. In 1960, Van Wyk and Grumbach first described a syndrome characterised by breast development, uterine bleeding and multicystic ovaries in the presence of long standing primary hypothyroidism. We describe an interesting case of 8 year old girl presented with the complaint of abdominal mass with history of premature menarche and breast development. She is found to have gross hypothyroidism, hyperprolactinemia, prepubertal LH levels, multicystic ovaries and delayed bone age. Thyroid replacement amazingly settled her problems bringing her to normalcy.
Styne DM, Grumbach MM. William's textbook of Endocrinology. 11th ed. Saunders Puberty. Ontogeny, neuroendocrinology, physiology and disorders. Elsevier. Philadelphia;2008:969-1166.
Taher BM, Ajlouni HK, Hamamy HA Shegem NS, Madanat AY, Ajlouni KM. Precocious puberty at an endocrine centre in Jordan. Eur J Clin Invest. 2004;34:599-604.
Wormsbecker A, Clarson C. Acquired primary hypothyroidism: vaginal bleeding in a quiet child. CMAG. 2010;182:588-590.
Bassam T, Ajlouni K. A case of ovarian enlargement in severe primary hypothyroidism and review of the literature. Ann Saudi Med. 2006;26(1):66-8.
DeLeener A, Montanelli L, VanDurme J, Chae H, Smits G, Vassart G, Costagliola S. Presence and absence of follicle stimulating hormone receptor mutations provide some insights into spontaneous ovarian hyper stimulation syndrome pathophysiology. J Clin Endocrinol Metab. 2006;91:555-62.
Shu J, Xing L, Zhang L, Fang S, Huang H. Ignored adult primary hypothyroidism presenting chiefly with persistent ovarian cysts: a need for increased awareness. Reprod Biol Endocrinol. 2011;9:119.
Ryan GL, Feng X, d'Alva CB, Zhang M, VanVoorhis BJ, Pinto EM et al. Evaluating the roles of follicle-stimulating hormone receptor polymorphisms in gonadal hyperstimulation associated with severe juvenile primary hypothyroidism. J Clin Endocrinol Metab. 2007;92:2312-7.
Durbin KL, Diaz-Montes T, Loveless MB. Van Wyk and Grumbach syndrome: an unusual case and review of the literature. J Pediatr Adolescent Gynaecol. 2011;24:93-96.
Sharma Y, Bajpai A, Mittal S, Kabra M, Menon PSN. Ovarian cysts in young girls with hypothyroidism: follow up and effect of treatment. J Pediatr Endocrinol Metab. 2006;19:895-900.
Hunold A, Alzen G, Wudy SA, BluettersSawatzki R, Landmann E Reiter A et al. Ovarian tumour in a 12-year old female with severe hypothyroidism: a case of Van Wyk and Grumbach syndrome. Pediatr Blood Cancer. 2009;52:677-9.
Krassas GE, Poppe K, Glinoer D. Thyroid function and human reproductive health. Endocrine Rev. 2010;31:702-755.
Thackray VG, Mellon PL, Coss D. Hormones in synergy: regulation of the pituitary gonadotropin genes. Molecular Cellular Endocrinol. 2010;314:192-203.
Kroeze WK, Sheffler DJ, Roth BL. G-protein-coupled receptors at a glance. J Cell Sci. 2003;116:4867-9.