1
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Fernandez-Gonzalez SM, Perez Vila MM, Prado-Carro AM. Precocious Puberty in Hypothyroidism: Mini-Review of Van Wyk-Grumbach Syndrome. J Endocr Soc 2023; 7:bvad135. [PMID: 38024650 PMCID: PMC10652332 DOI: 10.1210/jendso/bvad135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Indexed: 12/01/2023] Open
Abstract
Severe hypothyroidism can affect a variety of organs and can develop atypical manifestations. Peripheral precocious puberty may be secondary to other endocrinological diseases, which must be taken into account in the differential diagnosis in order to avoid unnecessary additional tests. Van Wyk-Grumbach syndrome is an infrequent manifestation characterized by severe hypothyroidism and incomplete precocious puberty. Diagnosis is made by clinical and complementary tests, and the main treatment goal is to achieve euthyroidism through hormone replacement. Prognosis is good once the treatment is established. The aim of this study is to review the available literature about Van Wyk-Grumbach syndrome following the PRISMA statement, and to present the first clinical case published in Spain. We have included the articles published during the period from 1905 to week 40 of 2022. A total of 68 articles have been selected for study and analysis, within which there are 99 published clinical cases. Girls accounted for 92.1% of cases (median age at the diagnosis 8.5 years). Metrorrhagia was the most prevalent symptom, present in 80.5% of the girls. Abdominal ultrasound was performed in 93.3% of the girls and 97.8% of them had at least one ovarian cyst. All cases were treated with levothyroxine, responding satisfactorily after the first doses of treatment. To conclude, Van Wyk-Grumbach syndrome is characterized by severe hypothyroidism and incomplete precocious puberty, which is important to keep in mind in order to avoid complementary exams and unnecessary surgical interventions.
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Affiliation(s)
| | | | - Ana Maria Prado-Carro
- Endocrinology Department, Complexo Hospitalario Universitario de A Coruña, 15006 A Coruña, Spain
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2
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Kusuma Boddu S, Ayyavoo A, Hebbal Nagarajappa V, Kalenahalli KV, Muruda S, Palany R. Van Wyk Grumbach Syndrome and Ovarian Hyperstimulation in Juvenile Primary Hypothyroidism: Lessons From a 30-Case Cohort. J Endocr Soc 2023; 7:bvad042. [PMID: 37197410 PMCID: PMC10184442 DOI: 10.1210/jendso/bvad042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Indexed: 05/19/2023] Open
Abstract
Context Prolonged hypothyroidism in children commonly causes short stature with delayed bone maturation, and delayed puberty. However, a paradoxical occurrence of peripheral precocious puberty and pituitary enlargement in chronically untreated juvenile hypothyroidism was first reported by Van Wyk and Grumbach in 1960. Objective To create increased awareness and a better understanding of this clinical entity among emergency room physicians, pediatricians, surgeons, gynecologists and oncologists. Methods Case records of children diagnosed with Van Wyk-Grumbach syndrome (VWGS) were analyzed retrospectively. Results Twenty-six girls and 4 boys were identified (2005-2020). All had profound primary hypothyroidism (total thyroxine [T4]: 2.5-33.5 nmol/L, thyrotropin: > 75-3744 μIU/mL). Hypothyroidism was not the referral diagnosis in any of the girls. Among them, 17 were referred for precocious puberty, 5 with a diagnosis of pituitary tumor on magnetic resonance imaging, and others for acute surgical abdomen in 7 girls (painful abdominal mass-2, ovarian tumor-2, ovarian torsion-2, ruptured ovarian cyst-1), acute myelopathy in 1, and menorrhagia with headache in another. All girls were successfully managed with levothyroxine replacement alone, except for the 2 with ovarian torsion, who required surgery. Menstruation ceased promptly with T4 therapy in all girls, occurring at an age-appropriate later date. All boys had testicular enlargement at presentation that regressed partially after T4 treatment. Catch-up growth was remarkable during the first treatment year, but the final height was compromised in all. Conclusion Increased awareness of varied presentations of VWGS is vital among pediatricians to facilitate early diagnosis and targeted investigations, and to help in the initiation of the simple yet highly rewarding T4 replacement therapy to avoid all possible complications.
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Affiliation(s)
- Sirisha Kusuma Boddu
- Pediatric & Adolescent Endocrinology, Rainbow Children's Hospital, Hyderabad 5000814, India
| | - Ahila Ayyavoo
- Pediatric and Adolescent Endocrinology, G. Kuppuswamy Naidu Memorial Hospital, Coimbatore 641037, India
| | - Vani Hebbal Nagarajappa
- Pediatric and Adolescent Endocrinology, Indira Gandhi Institute of Child Health, Bangalore 560029, India
| | | | - Shantakumar Muruda
- Clinical Biochemistry, Sagar Hospital, Jayanagar, Bangalore 560041, India
| | - Raghupathy Palany
- Correspondence: Raghupathy Palany, MBBS, DCH, MD, FRCP, Sagar Hospitals, Nos. 44-54, 30th Cross Rd, 4th T Block E, Tilak Nagar, Jayanagar, Bangalore, Karnataka 560041, India.
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3
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Muacevic A, Adler JR, Elmoheen R. Spontaneous Ovarian Hyperstimulation Syndrome Associated With Primary Hypothyroidism. Cureus 2023; 15:e33247. [PMID: 36606102 PMCID: PMC9808876 DOI: 10.7759/cureus.33247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2023] [Indexed: 01/03/2023] Open
Abstract
Ovarian hyperstimulation syndrome is a rare condition in pregnant women. Most cases are associated with the use of ovulation induction and stimulation medications. Some studies have reported cases of this condition in non-pregnant women or women undergoing ovulation therapy. In this case report, we report the case of a 27-year-old pregnant Saudi woman presenting with a picture of severe spontaneous ovarian hyperstimulation syndrome secondary to severe undiagnosed hypothyroidism. Treatment with Eltroxin (thyroxine) led to complete improvement and regression of ovarian enlargement after empirical titrating thyroxin replacement therapy, which proved the presence of this causation. The diagnosis was confirmed by laboratory and imaging findings, which helped prompt management and prevented complications of unneeded surgical intervention.
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4
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Prolonged Untreated Disease and Limited English Proficiency: A Case of Van Wyk-Grumbach Syndrome. J Adolesc Health 2021; 69:171-174. [PMID: 33221188 DOI: 10.1016/j.jadohealth.2020.10.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 10/03/2020] [Accepted: 10/12/2020] [Indexed: 11/23/2022]
Abstract
Children from families with limited English proficiency have worse health outcomes than those from English-speaking families, likely related to the impact of a variety of social determinants on an increased risk of delayed presentation, diagnosis, and loss to follow-up. Van Wyk-Grumbach syndrome (VWGS) is a result of prolonged untreated primary hypothyroidism and early diagnosis of hypothyroidism is critical to prevent VWGS from developing. Whether social determinants of health, particularly limited English proficiency, impact the development, diagnosis, and treatment of VWGS has not been discussed previously. Here, we describe the case of an adolescent girl diagnosed with VWGS whose primary caregiver is foreign-born and with limited English proficiency, explore factors that may have placed her at increased risk for delayed presentation of VWGS, and discuss ongoing challenges of her disease management. We briefly review the pathophysiology of VWGS, emphasize the importance of being sensitive to this atypical presentation of hypothyroidism, and explore the intersections of this case with limited English proficiency status.
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5
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Van Wyk Grumbach syndrome with precocious puberty and ovarian cysts: Value of thyroid function tests. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2019.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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6
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Leonardi A, Penta L, Cofini M, Lanciotti L, Principi N, Esposito S. Rhabdomyolysis in a Young Girl with Van Wyk-Grumbach Syndrome due to Severe Hashimoto Thyroiditis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15040704. [PMID: 29642533 PMCID: PMC5923746 DOI: 10.3390/ijerph15040704] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 03/31/2018] [Accepted: 03/31/2018] [Indexed: 11/16/2022]
Abstract
Background: Autoimmune hypothyroidism (Hashimoto thyroiditis; HT) is the most common postnatal thyroid disease. Clinical manifestations of HT vary according to disease severity. Due to the pleiotropic effects of thyroid hormone, less common signs and symptoms of HT can occur, leading to a delay in diagnosis. Case presentation: A 9-year-old girl of Indian origin was admitted for a one-week history of widespread myalgia, fatigue, muscle weakness, difficulty walking, and a significant increase in weight (approximately 2 kg) without any changes in daily habits. The only relevant medical history was several intermittent vaginal bleeding episodes since four years of age. Breast development was consistent with Tanner stage 2 without pubic or axillary hair; while height and weight were at the 10th percentile and the 38th percentile; respectively. Bone age from a left wrist X-ray was delayed 1 year. Pelvic ultrasonography revealed a uterine body/neck ratio of >1 (pubertal stage) and multifollicular ovaries. Her external genitalia had a childlike appearance. Laboratory examinations showed an increased thyroid-stimulating hormone, decreased free thyroxine, and positive anti-thyroglobulin antibody titres, as well as elevation of creatine phosphokinase, myoglobin, lactate dehydrogenase, serum aspartate aminotransferase, hypercholesterolemia, and a basal serum prolactin near the upper limit of normal. Follicle stimulating hormone and estradiol were slightly and significantly elevated, respectively. Thyroid ultrasound showed an increased gland size with irregular echostructures and high vascularization. Levothyroxine replacement therapy led to complete normalization of clinical and laboratory findings, including rhabdomyolysis indices. No further vaginal bleeding episodes were reported. Conclusion: This case report highlights how various can be the clinical picture of HT in children, and how rare clinical manifestations can be the only signs of disease at presentation leading to delayed diagnosis and treatment. In this girl, a never-described association of Van Wyk-Grumbach syndrome and acute rhabdomyolysis in a young girl with previously unrecognized HT is described. The importance of recognizing the signs and symptoms of rare complications of HT in order to begin appropriate therapy is stressed.
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Affiliation(s)
- Alberto Leonardi
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia 06132, Italy.
| | - Laura Penta
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia 06132, Italy.
| | - Marta Cofini
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia 06132, Italy.
| | - Lucia Lanciotti
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia 06132, Italy.
| | | | - Susanna Esposito
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Perugia 06132, Italy.
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7
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Ayub SS, Ruzic A, Taylor JA. Ovarian cysts, vaginal bleeding and hypothyroidism in a 4-year-old female with Down Syndrome: A case of Van Wyk-Grumbach Syndrome. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2017. [DOI: 10.1016/j.epsc.2017.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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8
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Cabar FR. Ovarian hyperstimulation syndrome in a spontaneous singleton pregnancy. ACTA ACUST UNITED AC 2017; 14:231-4. [PMID: 27223308 PMCID: PMC4943359 DOI: 10.1590/s1679-45082016rc3429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 09/30/2015] [Indexed: 11/21/2022]
Abstract
The ovarian hyperstimulation syndrome is the combination of increased ovarian volume, due to the presence of multiple cysts and vascular hyperpermeability, with subsequent hypovolemia and hemoconcentration. We report a case of spontaneous syndrome in a singleton pregnancy. This was a spontaneous pregnancy with 12 weeks of gestational age. The pregnancy was uneventful until 11 weeks of gestational age. After that, the pregnant woman complained of progressive abdominal distention associated with abdominal discomfort. She did not report other symptoms. In the first trimester, a routine ultrasonography showed enlarged ovaries, multiples cysts and ascites. Upon admission, the patient was hemodynamically stable, her serum β-hCG was 24,487mIU/mL, thyroid-stimulating hormone was 2.2µUI/mL and free T4 was 1.8ng/dL. All results were within normal parameters. However, levels of estradiol were high (10,562pg/mL). During hospitalization, she received albumin, furosemide and prophylactic dose of enoxaparin. The patient was discharged on the sixth hospital day.
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9
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Zhang S, Yang J, Zheng R, Jiang L, Wei Y, Liu G. VanWyk-Grumbach syndrome in a male pediatric patient: A rare case report and literature review. Exp Ther Med 2017; 13:1151-1154. [PMID: 28450956 DOI: 10.3892/etm.2017.4086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2015] [Accepted: 11/25/2016] [Indexed: 11/05/2022] Open
Abstract
Primary hypothyroidism usually leads to retardation of linear growth and delay or even arrest of puberty in juvenile patients. In rare cases, pediatric patients with hypothyroidism may present with signs of VanWyk-Grumbach's syndrome (VWGS), which includes juvenile hypothyroidism, delayed bone age and pseudoprecocious puberty. The present study reported on a rare case of VWGS and other complications, including obesity, short stature, hepatomegaly and pituitary hyperplasia. In addition, a comprehensive literature review was performed to illustrate the treatment and outcome of VWGS in pediatric patients. The present study contributed to the current knowledge regarding the diagnosis and treatment of VWGS in pediatric patients.
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Affiliation(s)
- Shanshan Zhang
- Department of Pediatrics, General Hospital of Tianjin Medical University, Tianjin 300052, P.R. China
| | - Jingyan Yang
- Department of Pediatrics, General Hospital of Tianjin Medical University, Tianjin 300052, P.R. China
| | - Rongxiu Zheng
- Department of Pediatrics, General Hospital of Tianjin Medical University, Tianjin 300052, P.R. China
| | - Lihong Jiang
- Department of Pediatrics, General Hospital of Tianjin Medical University, Tianjin 300052, P.R. China
| | - Ying Wei
- Department of Pediatrics, General Hospital of Tianjin Medical University, Tianjin 300052, P.R. China
| | - Geli Liu
- Department of Pediatrics, General Hospital of Tianjin Medical University, Tianjin 300052, P.R. China
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10
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Kocova M, Zdraveska N, Kacarska R, Kochova E. Diagnostic approach in children with unusual symptoms of acquired hypothyroidism. When to look for pituitary hyperplasia? J Pediatr Endocrinol Metab 2016; 29:297-303. [PMID: 26587741 DOI: 10.1515/jpem-2015-0157] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 09/30/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pituitary hyperplasia secondary to primary longstanding hypothyroidism has been reported in the literature in adults and rarely in children. METHODS Here we present the clinical presentation and diagnostic procedures in eight children with pituitary hyperplasia due to autoimmune thyroiditis, highlighting common findings, such as growth delay, fatigue or gaining weight, but also exceptional findings such as pericardial effusion, rhabdomyolysis, isolated hypertrichosis, and Van Wyk-Grumbach syndrome, which have rarely or never been described. RESULTS AND CONCLUSIONS Surprisingly no thyroid enlargement was detected. We discuss the unusual presenting signs of autoimmune thyroiditis that should raise the suspicion of pituitary hyperplasia. We suggest that a more elaborate clinical assessment and even modification of the diagnostic approach to autoimmune thyroiditis is needed in order to avoid its serious complications.
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11
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Rajaram S, Bhaskaran S, Aggarwal P, Goel N. Spontaneous ovarian hyperstimulation mimicking ovarian neoplasm: A rare complication of hypothyroidism. J OBSTET GYNAECOL 2015; 35:532-3. [DOI: 10.3109/01443615.2014.968112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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12
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Christens A, Sevenants L, Toelen J, Bullens D, Casteels K. Van Wyk and Grumbach syndrome: an unusual form of precocious puberty. Gynecol Endocrinol 2014; 30:272-6. [PMID: 24568556 DOI: 10.3109/09513590.2013.871523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
An 8-year-old girl presented with precocious menstruation and growth delay. Laboratory data revealed hypothyroidism and an X-ray of the wrist showed a delayed bone age. The Van Wyk and Grumbach syndrome (VWGS) was diagnosed and thyroid replacement was started with resolution of the symptoms. The association of precocious puberty and/or polycystic ovaries, delayed bone age and hypothyroidism is known as the Van Wyk and Grumbach syndrome. Clinically this syndrome is a diagnostic challenge because hypothyroidism usually leads to pubertal and growth delay, whereas in case of VWGS hypothyroidism it leads to growth delay and precocious puberty. The pathophysiology of VWGS is not yet clear, but the most accepted theory states that the high concentrations of TSH are sufficient to cause activation of the FSH receptor and produce gonadal enlargement. Thyroid replacement therapy results in a resolution of all signs and symptoms. For this reason, conservative management of the ovarian masses is advocated. Our case is unique as this girl did not have breast development or multicystic ovaries (as the other cases in the literature). This may be due to an early recognition and relatively low TSH levels in comparison to other cases.
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Affiliation(s)
- Anja Christens
- Department of Pediatrics, University Hospitals Leuven , Leuven , Belgium
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13
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Hu YY, Li GM, Hu WW, Wang Y. Characteristics of girls with pituitary hyperplasia and sexual precocity secondary to primary hypothyroidism. Acta Paediatr 2014; 103:e43-8. [PMID: 24118058 DOI: 10.1111/apa.12444] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 07/25/2013] [Accepted: 09/30/2013] [Indexed: 11/28/2022]
Abstract
AIM To investigate the different characteristics of girls with pituitary hyperplasia secondary to primary hypothyroidism (PPH), with and without sexual precocity. METHODS Pituitary hyperplasia secondary to primary hypothyroidism girls were divided into two groups: group A, with sexual precocity (n = 8), and group B, without sexual precocity (n = 14). The following values were measured before and after 3 months levothyroxine therapy: free triiodothyronine (FT3 ), free thyroxine (FT4 ), thyrotropin (TSH), follicle-stimulating hormone (FSH), luteinising hormone (LH), prolactin (PRL), estradiol (E2 ), testosterone (T), pituitary height, uterine volume (UV), ovarian volume (OV) and follicular diameter (FD). RESULTS Thyrotropin, FSH, PRL, E2 , T, pituitary height, UV, OV and FD were higher in group A than group B (all p < 0.05); FT3 , FT4 and LH levels were not different (all p > 0.05). In all of the PPH girls, pituitary height was correlated with FT3 , FT4 and PRL (r = -0.545, p = 0.009, r = -0.567, p = 0.006 and r = 0.666, p = 0.001, respectively). PRL was positively correlated with UV, FD and FSH (r = 0.581, p = 0.005, r = 0.482, p = 0.031 and r = 0.667, p = 0.001, respectively), and FSH was positively correlated with OV (r = 0.522, p = 0.013). These abnormalities regressed after therapy. CONCLUSION Pituitary hyperplasia secondary to primary hypothyroidism girls with sexual precocity have increased plasma TSH, FSH, PRL, E2 and T levels, pituitary height and uterine, ovarian and follicular size.
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Affiliation(s)
- Yan-Yan Hu
- Department of Pediatrics; Provincial Hospital Affiliated to Shandong University; Jinan China
| | - Gui-Mei Li
- Department of Pediatrics; Provincial Hospital Affiliated to Shandong University; Jinan China
| | - Wen-Wen Hu
- Department of Pediatrics; The People's Hospital of Lanshan District; Linyi China
| | - Yi Wang
- Department of Pediatrics; Provincial Hospital Affiliated to Shandong University; Jinan China
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14
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Sridev S, Barathan S. Case report on spontaneous ovarian hyperstimulation syndrome following natural conception associated with primary hypothyroidism. J Hum Reprod Sci 2013; 6:158-61. [PMID: 24082659 PMCID: PMC3778607 DOI: 10.4103/0974-1208.117164] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 02/07/2013] [Accepted: 04/13/2013] [Indexed: 11/04/2022] Open
Abstract
Spontaneous OHSS is a rare event in pregnancy following natural conception and only a few cases have been reported in the literature so far. This report is a case of spontaneously conceived pregnancy with Spontaneous OHSS and Primary hypothyroidism.
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Affiliation(s)
- Smisha Sridev
- Department of Reproductive Medicine, Parvathi Nursing Home, KK Nagar, Chennai, Tamil Nadu, India
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15
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Cabrera SM, DiMeglio LA, Eugster EA. Incidence and characteristics of pseudoprecocious puberty because of severe primary hypothyroidism. J Pediatr 2013; 162. [PMID: 23196132 PMCID: PMC4070005 DOI: 10.1016/j.jpeds.2012.10.043] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Severe primary hypothyroidism is a presumed rare cause of pseudoprecocious puberty (PsPP). Here, we report a 24% incidence of PsPP among 33 children with profound hypothyroidism. Those with PsPP were older and trended toward a higher thyroid stimulating hormone. Increased awareness of PsPP can hasten diagnosis and appropriate treatment.
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Affiliation(s)
- Susanne M Cabrera
- Section of Endocrinology/Diabetology, Department of Pediatrics, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN, USA.
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16
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Tran S, Kim EE, Chin AC. Severe menorrhagia, unilateral ovarian mass, elevated inhibin levels, and severe hypothyroidism: an unusual presentation of Van Wyk and Grumbach syndrome. J Pediatr Surg 2013; 48:e51-4. [PMID: 23331842 DOI: 10.1016/j.jpedsurg.2012.10.064] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2012] [Revised: 10/31/2012] [Accepted: 10/31/2012] [Indexed: 11/17/2022]
Abstract
A 10 year old female presented with a 3 week history of persistent vaginal bleeding, lower abdominal pain, and generalized fatigue. Further work-up determined that she had severe autoimmune hypothyroidism, precocious puberty, and a large left cystic ovarian mass, consistent with Van Wyk and Grumbach syndrome. In addition, the patient had elevated inhibin A and B levels, which may be elevated in granulosa cell tumor. The patient was managed with thyroid hormone replacement therapy and careful observation. Complete resolution of the ovarian mass and interval normalization of the inhibin levels were achieved. In females with severe primary hypothyroidism, ovarian masses, and elevated tumor markers, operative resection may be avoided with appropriate thyroid replacement therapy and close observation.
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Affiliation(s)
- Sifrance Tran
- Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL 60611, USA
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17
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Male Child with Van Wyk-Grumbach's Syndrome and Other Complications of Long-Standing Primary Hypothyroidism: A Case Report. Case Rep Pediatr 2012; 2012:352751. [PMID: 23133775 PMCID: PMC3485864 DOI: 10.1155/2012/352751] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Accepted: 10/03/2012] [Indexed: 11/29/2022] Open
Abstract
Primary hypothyroidism in the juvenile population generally leads to retardation of linear growth and delay or even arrest of puberty. However, in rare conditions, children with long-standing hypothyroidism present with signs of Van Wyk-Grumbach's syndrome (VWGS) which include juvenile hypothyroidism, delayed bone age, and pseudoprecocious puberty. We report a rare case of prepubertal male child from Asian origin, presented with long-standing untreated hypothyroidism complicated with VWGS and other complications including obesity, short stature, hepatomegaly, asymptomatic mild pericardial effusion, and pituitary hyperplasia.
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Motamed F, Eftekhari K, Kiani MA, Rabbani A. Ovarian Cyst Enlargement in a 14 Year Old Female with Persistent Ascities, Severe Hypothyroidism and Elevated Serum CA-125 Level. IRANIAN RED CRESCENT MEDICAL JOURNAL 2012; 14:379-81. [PMID: 22924118 PMCID: PMC3420030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/10/2011] [Accepted: 10/17/2011] [Indexed: 11/24/2022]
Abstract
A 14 year old female complained of abdominal pain and distention with vomiting. The physical exam showed thyroid enlargement and ascites. The imaging evaluation demonstrated a large ovarian cyst. Laboratory tests depicted hypothyroidism and marked elevation of Carbohydrate antigen 125 (CA-125) levels. As the bone age was 10 years, more retarded than the chronological age, Van Wyk and Grumbach syndrome was suspected. Treatment with thyroid hormone was initiated and the condition improved dramatically with disappearance of symptoms and signs 5 weeks later.
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Affiliation(s)
- F Motamed
- Department of Gastroenterology, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - K Eftekhari
- Department of Pediatrics, Mousavi Hospital, Zanjan University of Medical Sciences, Zanjan, Iran
| | - M A Kiani
- Department of Gastroenterology, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran,Correspondence: Mohammad Ali Kiani, MD, Department of Gastroenterology, Children's Medical Center Hospital, Dr Gharib St, Keshavarz Blvd, Tehran, Iran. Tel.: +98-21-66924545, Fax: +98-21-66924545, E-mail:
| | - A Rabbani
- Department of Endocrinology, Children's Medical Center Hospital, Tehran University of Medical Sciences, Tehran, Iran
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19
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Baranowski E, Högler W. An unusual presentation of acquired hypothyroidism: the Van Wyk-Grumbach syndrome. Eur J Endocrinol 2012; 166:537-42. [PMID: 22170796 DOI: 10.1530/eje-11-0494] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The association in young females of long-standing primary hypothyroidism, isosexual precocious pseudopuberty and multicystic enlarged ovaries was first described in 1960 by Van Wyk and Grumbach. Since then, sporadic case reports have contributed to clarifying the key features of this syndrome. The unique elements that lead to this diagnosis are FSH-dominated sexual precocity combined with a delayed bone age in the presence of hypothyroidism. It is important to recognise this syndrome because initiating simple thyroid hormone replacement completely resolves symptoms and hormone abnormalities, avoiding unnecessary investigations for malignancies or surgical intervention. We describe an 8-year-old girl with autoimmune thyroiditis and severe long-standing hypothyroidism presenting with the clinical features of Van Wyk-Grumbach syndrome, a secondary TSH-secreting adenoma and hyperprolactinaemia. In addition, this girl presented with microcytic anaemia, elevated erythrocyte sedimentation rate (ESR) and two unusual features - a newly developed streaky hyperpigmented skin lesion and parathyroid hormone suppression despite vitamin D deficiency. Thyroxine replacement normalised all hormone abnormalities and shrunk the pituitary adenoma within 9 months, but the new skin lesion persisted. We review the literature and explore the pathophysiology of known and new features that give rise to speculation indicating stimulation of the FSH G protein-coupled receptor by excessive TSH, but LH suppression by hyperprolactinaemia.
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Affiliation(s)
- E Baranowski
- Department of Endocrinology and Diabetes, Birmingham Children's Hospital, Steelhouse Lane, Birmingham B4 6NH, UK.
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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. [PMID: 21861901 PMCID: PMC3184057 DOI: 10.1186/1477-7827-9-119] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2011] [Accepted: 08/23/2011] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Ovarian cysts are a common cause for gynecological surgery. However, some cysts are a direct result of endocrine disorders and do not require surgery. This report describes an unusual case in which persistent ovarian cysts are associated with primary hypothyroidism in a young woman. The data were collected by history-taking, physical examination, laboratory tests, ultrasound, magnetic resonance imaging and a histo-pathological study. In addition, the exons of the gene encoding the human follicle-stimulating hormone receptor were sequenced. DISCUSSION The patient had markedly elevated levels of thyroid-stimulating hormone and follicle-stimulating hormone and an enlarged pituitary gland. After treatment with thyroid hormone replacement, regression of the enlarged pituitary and the ovarian cysts was observed. The possible mechanisms of the pathophysiology are discussed below. SUMMARY It is necessary to consider hypothyroidism and other endocrine disorders in the differential diagnosis of adult patients with ovarian multiple cyst formation in order to prevent inadvertent ovarian surgery.
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Affiliation(s)
- Jing Shu
- Department of Obstetrics & Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Lili Xing
- Department of Obstetrics & Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Lingyan Zhang
- Department of Obstetrics & Gynecology, Xiasha Hospital, Hangzhou 310001, China
| | - Suhua Fang
- Department of Obstetrics & Gynecology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China
| | - Hefeng Huang
- Department of Reproductive Endocrinology, Women's Hospital, School of Medicine, Zhejiang University, Hangzhou 310006, China
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Durbin KL, Diaz-Montes T, Loveless MB. Van wyk and grumbach syndrome: an unusual case and review of the literature. J Pediatr Adolesc Gynecol 2011; 24:e93-6. [PMID: 21600802 DOI: 10.1016/j.jpag.2010.08.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2010] [Revised: 08/06/2010] [Accepted: 08/09/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND The syndrome consisting of primary hypothyroidism, precocious puberty, and massive ovarian cysts was termed Van Wyk and Grumbach syndrome in 1960. Little is known about the effect of the cysts on ovarian tumor markers. CASE A 12-year-old Caucasian female presented with headaches and fatigue. Imaging to evaluate her headaches revealed a pituitary macroadenoma. Soon after her macroadenoma was discovered, she presented to the emergency room with abdominal pain. Imaging at that time revealed massive bilateral ovarian masses with the left measuring 17 × 13 × 8.5 cm and the right measuring 18 × 11 × 10 cm. Ovarian tumor markers were drawn at this time, most of which were highly elevated. Subsequent evaluation revealed extreme hypothyroidism. Given these findings of a pituitary macroadenoma, bilateral ovarian masses, and severe hypothyroidism, the patient was diagnosed with Van Wyk and Grumbach syndrome. We followed the cyst conservatively and the ovaries and tumor markers returned to normal after adequate thyroid replacement. COMMENTS This case supports conservative treatment as the first-line approach to massive ovarian cysts caused by hypothyroidism. In addition this case shows that tumor markers can be abnormal in the absence of a malignancy in this setting. Before proceeding with surgical evaluation, exclusion of hypothyroidism to exclude this rare but treatable syndrome should be undertaken. The most important diagnostic clue that the cyst may be caused by an endocrine source is the finding of bilateral ovarian cysts rather than one ovary affected as seen in most ovarian malignancies in this age group.
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Affiliation(s)
- Kaci L Durbin
- University of Louisville School of Medicine, Louisville, Kentucky, USA
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Ovarian tumors with elevated CA-125 levels and severe juvenile hypothyroidism: a need for increased awareness. Indian J Pediatr 2010; 77:693-4. [PMID: 20532693 DOI: 10.1007/s12098-010-0081-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Accepted: 02/04/2010] [Indexed: 10/19/2022]
Abstract
A 15-yr-old girl presented with bilateral gross ovarian tumors, clinical features of long-standing unrecognized hypothyroidism and markedly elevated CA-125 levels. Ovarian resection was avoided, as the presentation was consistent with the Van Wyk and Grumbach syndrome; and the patient was treated with replacement of thyroid hormone. Regression of the ovarian tumors occurred 6 months after initiation of the treatment. The authors emphasise the need for increased awareness and screening for hypothyroidism in patients with ovarian tumors, in order to prevent inadvertent operative interventions.
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