Abstract
Background: Hypothyroidism in childhood typically leads to delayed puberty, rarely can it cause precocious puberty - this latter complex is eponymously known as Van-Wyk Grumbach syndrome.
 Case description: We report a case of a seven and a half-year-old girl who was referred with vaginal bleeding after a diagnosis of primary hypothyroidism and starting treatment with levothyroxine. This case report illustrates the typical features of this rare syndrome for primarily educational purposes. Many case reports of Van Wyk Grumbach syndrome have been published in world literature over the past seven decades after the initial description. Though the features of this syndrome are fairly well described previously, the understanding of pathophysiological mechanisms is speculative and still evolving.
 Clinical relevance: Further widespread awareness of the complex will encourage primary physicians and pediatricians to counsel the family of a child before starting treatment for hypothyroidism which will help avoid unnecessary worry and more importantly inadvertent procedures or intervention.
Highlights
Van Wyk and Grumbach first described this eponymous syndrome 60 years back as an association of hypothyroidism with precocious puberty (PP) and ovarian mass.[1]
We describe a girl child who was referred to our endocrinology out-patient department with menstrual bleeding after starting treatment for hypothyroidism
Clinical pointers to differentiate it from true (GnRH dependent) precocious puberty include first; thelarche and menarche without pubarche, second; short stature as opposed to increased height velocity in GnRH dependent PP, and third; delayed bone age compared to height age and both less than chronological age as illustrated in this case.[3]
Summary
Van Wyk and Grumbach first described this eponymous syndrome 60 years back as an association of hypothyroidism with precocious puberty (PP) and ovarian mass.[1] They mentioned it as an example of hormonal overlap in pituitary feedback; which is still an accepted pathophysiological mechanism for this peculiar syndrome It causes gonadotropin independent iso-sexual precocious puberty and manifests as such in female children; males may be affected too causing macroorchidism. CASE REPORT A 7 years and 4 months old girl was referred to our endocrine OPD with vaginal bleed since 4 days She was from a poor socioeconomic background, the product of a non-consanguineous marriage, third in birth order and was born at term after an uneventful antenatal period. There is no history of prolonged jaundice, hypoglycaemia, seizures, umbilical hernia, constipation or hypotonia She was breastfed till 2 years and achieved all milestones at appropriate age.
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