Van Wyk e Grumbach syndrome: case report
B. Francisco1, J. Haber2 & R. Santos1
Introduction: In 1960, Van Wyk and Grumbach described the association of hypothyroidism and precocious puberty. Hypothyroidism leads to delayed bone age and a reduction in growth rate by reducing the amplitude of GH pulses. When precocious puberty is associated with thyroid hypofunction, estrogen action on the epiphyseal plates reduce this delay. We report the case of a child who developed incomplete puberty and reduced growth rate, caused by primary hypothyroidism.
Case report: G. 7th, female, complaining to grow 1 cm in 1 year and weight gain. Father 172 cm tall and the mother 168 cm. Child with 115 cm, 29 kg, BMI: 22 and short stature. FC: 52, TSH> 100, IO 45 years. Treatment with levothyroxine, TSH normalize and child thinned, antibodies. After 6 months of starting treatment developed central precocious puberty: 0.66 LH, FSH 2 TO 9.4 and Prolactin 6:36 ng/ml - normal skull CT. M2 P1, TSH 0.09, T4 1.33, IO 5 years.
Discussion: Hypothyroidism is a rare cause of precocious puberty. Van Wyk and Grumbach proposed that chronic hypothyroidism cause a negative feedback to the absence of TSH, gonadotropins and prolactin and their removal would be responsible for increased levels of TRH. The high HRT cause the increase of FSH which in turn would trigger puberty. In this case the patient did not have hyperprolactinemia.
Conclusion: This syndrome, when untreated and recently diagnosed as well as physical damage loss in stature, can provide psychosocial impairment. Therefore, immediate action is necessary to lessen or prevent the damage height and provide psychological support to children and parents in order to avoid major behavioral disorders.
Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.
Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.