Unusually Enlarged Ovaries Associated with Severe Hypothyroidism - Van Wyk and Grumbach Syndrome Case Report

Dimitrije Cvetković; Slađana Todorović; Tatjana Milenković; Katarina Mitrović; Rade Vuković; Zarić Sanja Panić; Đorđe Savić; Tanja Mijović; Dijana Smolović; Jovana Tončev

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ESPE Abstracts (2022) 95 P1-398

ESPE2022 Poster Category 1 Thyroid (44 abstracts)

Unusually Enlarged Ovaries Associated with Severe Hypothyroidism - Van Wyk and Grumbach Syndrome Case Report

Dimitrije Cvetković ¹ , Slađana Todorović ¹ , Tatjana Milenković ¹ , Katarina Mitrović ^1,2 , Rade Vuković ^1,2 , Sanja Panić Zarić ¹ , Đorđe Savić ^1,2 , Tanja Mijović ¹ , Dijana Smolović ¹ & Jovana Tončev ¹

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¹Mother and Child Healthcare Institute of Serbia “Dr Vukan Čupić”, Belgrade, Serbia; ²Faculty of Medicine, University of Belgrade, Belgrade, Serbia

Introduction: Since 1960, enlarged polycystic ovaries associated with hypothyroidism, delayed bone age and precocious puberty are recognized as Van Wyk and Grumbach syndrome. Although it is rare entity, it should be considered in differential diagnosis of the enlarged polycystic ovaries.

Case: An eleven-year-old girl was presented with sudden onset of abdominal pain and vomiting. A large mass with multiple cysts was seen on the abdominal ultrasound. MRI of the abdomen at the time revealed massive bilateral enlarged polycystic ovaries (right measuring 141x134x85 mm and left 85x96x71 mm). She was obese with BMI of 30.01 kg/m2, with height of 138.3 cm (-1SD). Tanner stage was B2, A2, P2. Her TSH levels were significantly elevated at 704 mIJ/l (normal values 0.35-4.94) and was accompanied by hyperprolactinemia over 4200 mIJ/l (normal values 110-562) and anemia (hemoglobin level of 84 g/l). Her FSH and LH levels were within normal range. Bone age was delayed almost 3 years behind her chronological age. Menarche presented two years before admission to the hospital, with irregular menstrual cycles afterwards. After thorough evaluation, she was diagnosed with Van Wyk and Grumbach syndrome due to unrecognized chronic lymphocytic thyroiditis. She was treated with thyroid hormone replacement. After one month of treatment, positive progress in the clinical response was observed. Her TSH levels in serum dropped 118 mIJ/l, while ovaries measurements evaluated via ultrasound were much smaller (72x38x42 mm and 67x38x35 mm on the right and left side respectively).

Conclusion: When evaluating girls with enlarged polycystic ovaries and precocious puberty, possibility of severe hypothyroidism should be considered, especially in the presence of delayed bone age.