An unusual presentation of acquired hypothyroidism: the Van Wyk-Grumbach syndrome

Research output: Contribution to journalArticlepeer-review

Authors

  • E Baranowski
  • Wolfgang Högler

External organisations

  • Birmingham Children’s Hospital NHS Foundation Trust,

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.

Details

Original languageEnglish
Pages (from-to)537-42
Number of pages6
JournalEuropean Journal of Endocrinology
Volume166
Issue number3
Publication statusPublished - Mar 2012

Keywords

  • Child, Diagnosis, Differential, Female, Humans, Hypothyroidism, Ovarian Cysts, Puberty, Precocious, Ultrasonography, Case Reports, Journal Article