A 6-year-old girl is brought with complaints of breast development for 3 months and one episode of vaginal bleeding. She has a history of poor school performance, constipation, and cold intolerance. On examination, her height is 102 cm (<3rd centile), weight 16 kg, pulse 58/min, and she has dry, coarse skin with a firm, non-tender goiter. Bone age is 4 years. Laboratory tests show TSH 92 mIU/L (normal 0.5-5) and low free T4. What is the most likely diagnosis?

• A Central precocious puberty
• B Primary hypothyroidism (Van Wyk-Grumbach syndrome) ✓
• C McCune-Albright syndrome
• D Ovarian granulosa cell tumor

Explanation

Primary hypothyroidism can cause precocious puberty because elevated TSH cross-reacts with FSH receptors on the ovaries, leading to breast development and vaginal bleeding. Unlike true precocious puberty, bone age is delayed rather than advanced. McCune-Albright syndrome presents with café-au-lait spots and fibrous dysplasia. Ovarian tumor would cause a palpable mass and elevated estradiol with suppressed gonadotropins. Central precocious puberty would show advanced bone age and a pubertal LH response to GnRH.

Reference: Nelson Textbook of Pediatrics, 21st ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.