scholarly journals Premature Menarche Associated with Primary Hypothyroidism in a 5.5-Year-Old Girl

2011 ◽  
Vol 2011 ◽  
pp. 1-3
Author(s):  
Dhrubajyoti Sharma ◽  
Devi Dayal ◽  
Anju Gupta ◽  
Akshay Saxena
Keyword(s):  
Precocious Puberty ◽  
Vaginal Bleeding ◽  
Linear Growth ◽  
Pubertal Development ◽  
Primary Hypothyroidism ◽  
Autoimmune Hypothyroidism ◽  
Rare Association ◽  
History Of ◽  
Multiple Cysts

Children with hypothyroidism generally have delayed pubertal development. Rare association with precocious puberty may occur especially in long standing untreated patients. The cardinal features of hypothyroidism induced pseudo precocious pubertal development include thelarche, galactorrhea and menarche. Other characteristics features are an absence of sexual hair and retardation of linear growth. Its manifestation as isolated menarche has been rarely reported. Recently, a five and half year old girl presented to us with history of one episode of vaginal bleeding. A pelvic ultrasonogram revealed multiple cysts in both ovaries and subsequent investigations led to a diagnosis of autoimmune hypothyroidism.

scholarly journals Precocious Puberty with Primary Hypothyroidism due to Autoimmune Thyroiditis

2016 ◽  
Vol 34 (1) ◽  
pp. 45-47
Author(s):  
Setara Binte Kasem
Keyword(s):  
Precocious Puberty ◽  
Autoimmune Thyroiditis ◽  
Vaginal Bleeding ◽  
Linear Growth ◽  
Pubertal Development ◽  
Hormone Replacement ◽  
Primary Hypothyroidism ◽  
Thyroid Hormone Replacement ◽  
Rare Association ◽  
Characteristic Features

Children with hypothyroidism generally have delayed pubertal development. Rare association with precocious puberty may occur especially in long standing untreated patients. The cardinal features of hypothyroidism induced pseudoprecocious pubertal development include thelarche, galactorrhoea & menarche . Other characteristic features are absence of sexual hair & retardation of linear growth. In this report a rare case of vaginal bleeding, large multicystic ovaries, precocious puberty, slow physical & mental growth in a seven and half years old girl with hypothyroidism due to autoimmune thyroiditis is described. It is important to recognize this syndrome because initiating simple thyroid hormone replacement completely resolves symptoms and hormone abnormalities, avoiding unnecessary investigations for malignancies or surgical intervention.J Bangladesh Coll Phys Surg 2016; 34(1): 45-47

scholarly journals SAT-509 Sudden Onset of Malabsorption

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Gabriela Mroueh ◽  
James K Burks
Keyword(s):  
Medication Adherence ◽  
The Elderly ◽  
Sudden Onset ◽  
Primary Hypothyroidism ◽  
Caucasian Woman ◽  
Thyroid Function Tests ◽  
Autoimmune Hypothyroidism ◽  
High Clinical Suspicion ◽  
Immune Mediated ◽  
History Of

Abstract Celiac disease (CD) is an immune-mediated enteropathy caused by a reaction to gliadin which responds to a restriction to dietary gluten. It has been traditionally recognized in children and young adults, although, recently, detection in the elderly population has increased. CD occurs in 2–5% of patients with autoimmune hypothyroidism, and is more prevalent in this group than in the general population An 82-year-old Caucasian woman with primary hypothyroidism and a BMI of 16 is referred to our endocrinology clinic for help with the management of hypothyroidism. She had a history of well controlled hypothyroidism on weight-dosed levothyroxine for many years until several months prior when she developed sudden onset of diarrhea and weight loss. Since then, her thyroid function tests showed an elevated TSH despite medication adherence. Her levothyroxine dose was steadily increased to 300 mcg daily and yet, her TSH still remained elevated. Laboratory work up was done which revealed elevated transglutaminase antibodies, suggesting the diagnosis of CD. The patient refused an endoscopy for a tissue diagnosis. Even though the patient has been diagnosed with CD, she has trouble following a gluten free diet and still has intermittent diarrhea and high levothyroxine requirements. Although lack of medication adherence is common, it is important to exclude gastric or intestinal causes of malabsorption in patients with high thyroid replacement requirements. Elderly patients often have paucity of symptoms, so high clinical suspicion is necessary to diagnose these patients.

scholarly journals Unusual Presentation of Precocious Puberty Associated with Primary Hypothyroidism in a 8.5 Years Old Girl

2018 ◽  
Vol 6 (2) ◽  
pp. 102-105
Author(s):  
Shamsun Naher Rikta ◽  
Fatema Ashraf ◽  
Samira Areen
Keyword(s):  
Precocious Puberty ◽  
Rare Complication ◽  
Pubertal Development ◽  
Thyroid Function Test ◽  
Ovarian Tumour ◽  
Primary Hypothyroidism ◽  
Monthly Interval ◽  
Close Monitoring ◽  
College Hospital ◽  
Ovarian Volume

Precocious puberty is one of the gynaecological problems in childhood. Children with hypothyroidism generally have delayed pubertal development. But primary hypothyroidism is one of the rare causes of precocious puberty especially in long standing untreated patients. Bilateral ovarian enlargement due to multiple cystic ovaries is a rare complication of primary hypothyroidism. For ovarian enlargement no treatment is required at all. This is a case report of an 8.5 years old girl diagnosed as a case of precocious puberty with benign ovarian tumour at a peripheral hospital and was being prepared to undergo laparotomy. When patient was admitted at Shaheed Suhrawardy Medical College Hospital (ShSMCH), Dhaka, Bangladesh, after thorough investigations primary hypothyroidism was diagnosed. She was given thyroxin replacement and close monitoring was done by doing USG of uterus and adnexae, thyroid function test at monthly interval. USG after 2 months revealed significant reduction of ovarian volume and at 6 month ovarian volume reduced to normal. It was also noticed that the rate of reduction of ovarian volume corresponds to the rate of reduction of serum TSH level measured serially at every 2 months interval.Delta Med Col J. Jan 2018 6(2): 102-105

Precocious Puberty

2006 ◽  
Vol 00 (02) ◽  
Author(s):  
Paul B Kaplowitz
Keyword(s):  
Precocious Puberty ◽  
Linear Growth ◽  
Pubertal Development ◽  
Black Girls ◽  
Pubic Hair ◽  
Growth Spurt ◽  
Tall Stature ◽  
Early Puberty ◽  
Bone Maturation ◽  
Early Appearance

Precocious puberty refers to the appearance of physical and hormonal signs of pubertal development at an earlier age than is considered normal.Although traditionally, any signs of puberty in girls prior to age eight years have been considered abnormal, recent studies indicate that signs of early puberty (breasts and pubic hair) are often present in girls (particularly black girls) between ages 6–8 years.The early growth spurt initially can cause tall stature, but rapid bone maturation can cause linear growth to cease too early and result in short adult stature.The early appearance of breasts or menses in girls and increased libido in boys can cause emotional distress for some children.

scholarly journals Van wyk-grumbach syndrome: an unusual presentation of long standing hypothyroidism with early menarche.

2019 ◽  
Vol 2 (3) ◽  
pp. 01-04
Author(s):  
Hina Gul
Keyword(s):  
Young Children ◽  
Precocious Puberty ◽  
Vaginal Bleeding ◽  
Bone Growth ◽  
Unusual Presentation ◽  
Delayed Puberty ◽  
Polycystic Ovaries ◽  
Early Menarche ◽  
History Of

Hypothyroidism is generally associated with delayed puberty, but long standing untreated hypothyroidism in young children can lead to pseudo-precocious puberty. Hypothyroidism induced precocious puberty presents with thelarche, menarche, galactorrhea, absence of sexual hair, delayed bone growth also known as van wyk-grumbach syndrome. Here we report an 8 years old girl presented to us with history of cyclical per vaginal bleeding since age of 3 years. Upon further workup there were bilateral polycystic ovaries on ultrasonography, upon subsequent investigations child was diagnosed with hypothyroidism.Due to lack of neonatal screeing for hypothyroisdim,lack of awareness among genral population such cases are missed and often presents late to healthcare pfofessionals.

scholarly journals Isosexual precocious puberty with primary hypothyroidism: an interesting case report

2017 ◽  
Vol 6 (9) ◽  
pp. 4140
Author(s):  
Kaliki Hymavathi ◽  
Surekha Tadisetti ◽  
Divya Pusarla ◽  
Malini Devi Gottipati
Keyword(s):  
Case Report ◽  
Precocious Puberty ◽  
Abdominal Mass ◽  
Bone Age ◽  
Interesting Case ◽  
Primary Hypothyroidism ◽  
Uterine Bleeding ◽  
Breast Development ◽  
Girl Child ◽  
History Of

Isosexual precocious puberty in a girl child is defined as thelarche before 6 years in African–Americans and 7 years in Caucasians and menarche before the age of 9 years. In 1960, Van Wyk and Grumbach first described a syndrome characterised by breast development, uterine bleeding and multicystic ovaries in the presence of long standing primary hypothyroidism. We describe an interesting case of 8 year old girl presented with the complaint of abdominal mass with history of premature menarche and breast development. She is found to have gross hypothyroidism, hyperprolactinemia, prepubertal LH levels, multicystic ovaries and delayed bone age. Thyroid replacement amazingly settled her problems bringing her to normalcy. 

scholarly journals SUN-290 Pituitary Hyperplasia Due to Uncontrolled Primary Hypothyroidism: Case Series and Literature Review

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Juan Pablo Godoy Alonso ◽  
Germán González de la Cruz ◽  
Marlon Vladimir Vázquez-Aguirre ◽  
Andrea Rocha Haro ◽  
Karla Krystel Ordaz Candelario ◽  
...  
Keyword(s):  
Pituitary Gland ◽  
Feedback Inhibition ◽  
Case Series ◽  
Optic Chiasm ◽  
Primary Hypothyroidism ◽  
Autoimmune Hypothyroidism ◽  
Hormonal Replacement ◽  
Pituitary Hyperplasia ◽  
History Of

Abstract Background: Pituitary hyperplasia secondary to primary hypothyroidism results from the loss of thyroxine feedback inhibition and the subsequent overproduction of TSH. Case 1: A 18-year-old female presented with a chronic history of spontaneous galactorrhea, headache and malaise. Autoimmune primary hypothyroidism was diagnosed, with elevated TSH of 490 mIU/L (0.3-5) and low fT4 of 0.33 ng/dL (0.63-1.34). Pituitary MRI showed an enlarged pituitary with compression of the optic chiasm. Hormonal replacement with levothyroxine 75 mcg qd was started. Five months later she was asymptomatic, and normal TSH (1.64 mIU/L) and fT4 (0.9 ng/dL) levels. A new MRI revealed normal size of pituitary gland, with no compression of the optic chiasm and an intact infundibulum. Case 2: A 24-year-old female with type 1 diabetes and autoimmune primary hypothyroidism, presented with a five-year history of galactorrhea and oligomenorrhea. She was treated with insulin glargine 20U qd, and levothyroxine 200 mcg/day. However, patient’s adherence was bad. She consulted a primary health physician who suspected a prolactinoma after high prolactin levels (77.65, normal 2.64-13.13 ng/mL). Cabergoline was started without any clinical improvement. She then was referred to our service for follow-up. TSH results showed 500 mIU/L, with low fT4 (0.08 ng/dL). Prolactin levels was normal. Pituitary MRI revealed diffuse enlargement of the gland, with compression of infundibulum and optic chiasm. Treatment was modified to levothyroxine/liothyronine 100/20mcg 1 ½ tablet qd. After 7 months, we confirmed normal TSH (0.76 mIU/L) and fT4 (1.23 ng/dL), and the patient was asymptomatic. After 17 months, new MRI showed normal pituitary gland without any compression. Case 3: A 23-year-old female with a history of Addison′s disease and hypothyroidism diagnosed at age 17 presented with a 6-month history of somnolence, fatigue, headache and amenorrhea. She was previously treated with hydrocortisone 25mg/day, fludrocortisone 0.1mg/day, and levothyroxine 200mcg/day. Patient’s adherence was bad, and multiple hospitalizations because of adrenal crises were reported. Her initial hormonal evaluation revealed high TSH of 460 mIU/L and low fT4 of 0.25 ng/dL, mild hyperprolactinemia (32.16 ng/mL), and very high ACTH levels (2,700 pg/mL, normal 10-100). Pituitary MRI revealed an enlarged pituitary with mild compression of the optic chiasm. Hormonal replacement was modified to fasting levothyroxine alternating 200mcg and 300mcg qd. Her last follow-up showed normal TSH (0.53 mIU/L) and fT4 (1.18 ng/dL) levels. New MRI showed normal pituitary size Conclusion: We presented three young women, with autoimmune hypothyroidism, who developed pituitary hyperplasia and responded to proper hormonal replacement normalizing pituitary size. Reference: Endocrinol Diabetes Metab Case Rep. 2015; 2015: 150056.

scholarly journals A 4-Year-Old Girl with Precocious Puberty

2016 ◽  
Vol 6 (3) ◽  
pp. 161-163
Author(s):  
Poly Begum ◽  
Dipti Rani Saha ◽  
Md Kamrul Hassan
Keyword(s):  
Precocious Puberty ◽  
Vaginal Bleeding ◽  
Pubertal Development ◽  
Tanner Stage ◽  
Female Child ◽  
Pubic Hair ◽  
Breast Development ◽  
Average Height ◽  
Gonadotrophin Secretion ◽  
Hypothalamic Pituitary Axis

Appearance of secondary sexual development before the age of nine in a male child and before the age of eight in a female child is called precocious puberty. Precocious puberty due to premature activation of the hypothalamic-pituitary axis is called central or complete precocious puberty. Incomplete precocious puberty is called if ectopic gonadotrophin secretion occurs in boys or autonomous sex steroid secretion occurs in either sex. Here we report a case of a 4-year-old girl brought to a gynecologist by her parents because of breast development, pubic hair and periodic per vaginal bleeding. Her medical history was unremarkable. The parents were of average height, and the mother reported first menstruation when she was 11 years. At physical examination, the girl was 100 cm tall, weighed 17 kg, and had a body mass index of 17. Her pubertal development is classified as Tanner stage 3 breast development and Tanner stage 2 pubic hair development.J Enam Med Col 2016; 6(3): 161-163

scholarly journals Precocious puberty in Korean girls with and without exposure to endocrine-disrupting chemicals in toy slime: a comparative analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Mi Seon Lee ◽  
Gi Min Lee ◽  
Cheol Woo Ko ◽  
Jung Eun Moon
Keyword(s):  
Sex Hormones ◽  
Precocious Puberty ◽  
Pubertal Development ◽  
Endocrine Disrupting Chemicals ◽  
Tanner Stage ◽  
Bone Age ◽  
Stimulation Test ◽  
Releasing Hormone ◽  
Endocrine Disrupting ◽  
History Of

Abstract Background Toy slime is popular in Korea, and in parallel, pre-pubertal girls visit hospitals for early pubertal signs. Thus far, numerous studies have investigated the association of endocrine-disrupting chemicals (EDCs) with precocious puberty (PP). However, there is a lack of studies on the clinical manifestations and sex hormones. We aimed to investigate early pubertal development in Korean girls with or without a history of toy slime exposure and determine changes in bone age, Tanner stage, and sex hormones. Methods In this study, 140 girls underwent stimulation tests at Kyungpook National University Children’s Hospital Endocrinology Department, during January 2018 and December 2020. Patients were divided into two groups for gonadotropin-releasing hormone (GnRH) stimulation test and frequency of exposure to toy slime (EDCs). GnRH stimulation test was conducted after an intravenous injection of 100 µg of luteinizing hormone-releasing hormone. Slime exposure was defined as Slime ≥ 3 times/week for ≥ 3 months. Results History of slime exposure was found in 14 of 58 and 65 of 82 patients in the central PP (CPP) and non-CPP groups, respectively. Slime-exposed patients had advanced bone age, although their Tanner stage was low. Patients with a history of toy slime exposure were 5.5 times more likely to be diagnosed with non-CPP than patients without slime exposure (p < 0.05). Conclusions Exposure to toy slime in prepubertal girls may be associated with rapid clinical advancement of pubertal development and bone age, and the patients appear more likely to be diagnosed with non-CPP.

scholarly journals The Aromatase Inhibitor Anastrozole Is Ineffective in the Treatment of Precocious Puberty in Girls with McCune-Albright Syndrome

2008 ◽  
Vol 93 (7) ◽  
pp. 2751-2754 ◽  
Author(s):  
Jakub Mieszczak ◽  
Elizabeth S. Lowe ◽  
Paul Plourde ◽  
Erica A. Eugster
Keyword(s):  
Aromatase Inhibitor ◽  
Precocious Puberty ◽  
Growth Velocity ◽  
Vaginal Bleeding ◽  
Linear Growth ◽  
Skeletal Maturation ◽  
Average Growth ◽  
Mccune Albright Syndrome ◽  
Albright Syndrome ◽  
Mccune Albright

Abstract Context: Precocious puberty (PP) in girls with McCune-Albright syndrome (MAS) is characterized by episodic development of large unilateral ovarian cysts followed by sudden onset of vaginal bleeding. Some patients experience frequent bleeding as well as accelerated linear growth and advanced skeletal maturation. The use of anastrozole for the treatment of PP in this condition has not been well studied. Objective: The objective of the study was to determine the safety and efficacy of the aromatase inhibitor anastrozole for the treatment of PP in girls with MAS. Design and Settings: This was a prospective international multicenter study in which subjects received anastrozole 1 mg daily for 1 yr. Patients: Twenty-eight girls 10 years of age or younger with MAS and progressive PP were enrolled. Main Outcome Measures: Vaginal bleeding, rate of skeletal maturation (change in bone age over change in chronological age), growth velocity, and uterine/ovarian volumes were measured. These indices were compared with a 6-month pretreatment interval. Results: No difference in vaginal bleeding (mean number of days per year) was noted. Mean change in ΔBA/ΔCA, which was 1.25 ± 0.77 at baseline, was −0.25 ± 1.02 at study end (P = 0.22). Average growth velocity z score was 1.40 ± 3.15 at study entry and 0.26 ± 2.71 at 12 months (P = 0.10). Mean ovarian/uterine volumes were unaffected by anastrozole, and no significant adverse events occurred. Conclusions: Although it appears safe, anastrozole for 1 yr was ineffective in halting vaginal bleeding, attenuating rates of skeletal maturation, and linear growth in girls with MAS. Pharmacological strategies other than anastrozole should be pursued for the treatment of PP in this population.

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