Pseudoprecocious Puberty in a Patient with Severe Primary Hypothyroidism (Van Wyk-Grumbach Syndrome)

 

Synonym: Van Wyk-Grumbach syndrome

 

Patient selection: severe hypothyroidism (may be undiagnosed), usually of short stature

 

Findings in female:

(1) breast development with galactorrhea

(2) vaginal bleeding

(3) enlarged multi-cystic ovaries

(4) enlarged uterus

 

Findings in male:

(1) testicular enlargement

(2) absence of virilization

 

Laboratory findings:

(1) low thyroxine and markedly elevated TSH

(2) elevated prolactin

(3) normal to elevated estradiol

(4) normal to elevated FSH

(5) suppressed LH

 

Thyroid hormone replacement will reverse the findings.