Van Wyk–Grumbach syndrome: Decoding the mystery of precocious puberty with delayed bone age

ABSTRACT A 5-year 7-month-old girl was brought by her mother due to an inability to gain height for 3.5 years, associated with facial puffiness, dry and coarse skin, and constipation for the past 3 years. Physical examination revealed stigmata of hypothyroidism along with bilateral breast enlargement. Investigations showed elevated thyroid-stimulating hormone levels, elevated prolactin levels, elevated anti-thyroid peroxidase antibody levels, low luteinizing hormone levels, bilateral ovarian cysts on ultrasound, and delayed bone age. She was diagnosed with disproportionate severe short stature and gonadotropin-independent isosexual precocity, that is, Van Wyk–Grumbach syndrome due to autoimmune hypothyroidism.