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Case Reports
. 2025 Feb:127:110975.
doi: 10.1016/j.ijscr.2025.110975. Epub 2025 Jan 28.

Van Wyk-Grumbach Syndrome with bilateral inguinal hernia: A case report

Dhiran Sivasubramanian  1 , Virushnee Senthilkumar  2 , Smrti Aravind  2 , Aswin Ram Rajasekar  2 , Sharan Prasaanth  2 , Sathwik Sanil  3
Affiliations
Case Reports

Van Wyk-Grumbach Syndrome with bilateral inguinal hernia: A case report

Dhiran Sivasubramanian et al. Int J Surg Case Rep. 2025 Feb.

Abstract

Introduction: Van Wyk-Grumbach Syndrome (VWGS) is a rare pediatric endocrinological disorder characterized by hypothyroidism, delayed bone age, enlarged multicystic ovaries, and precocious puberty. It results from prolonged hypothyroidism, affecting the hypothalamic-pituitary-gonadal axis. This report describes a 7-year-old girl presenting with vaginal bleeding and abdominal pain, leading to a diagnosis of VWGS with bilateral inguinal hernia and requiring surgical intervention.

Case presentation: A 7-year-old girl presented with a single episode of vaginal bleeding, abdominal pain, and growth retardation. Clinical examination revealed delayed growth parameters, Tanner stage II breast development, and bilateral inguinal hernias. Abdominal examination identified a cystic mass in the right iliac fossa. Laboratory tests showed hypothyroidism. Imaging revealed a multiloculated right ovarian cyst. The patient underwent exploratory laparotomy with right salpingo-oophorectomy, marsupialization of the left ovarian cyst, and bilateral hernia repair. Histopathology confirmed ovarian hemorrhagic infarction. Postoperatively, she was started on levothyroxine therapy, leading to symptom resolution, height improvement, and cyst regression during follow-up.

Clinical discussion: VWGS manifests due to thyroid dysfunction-induced gonadal stimulation, causing ovarian enlargement and precocious puberty. Prompt initiation of levothyroxine can prevent complications and avoid surgical intervention. The bilateral hernias in this case represent a unique presentation, potentially linked to hypothyroidism-induced muscle weakness.

Conclusion: This case underscores the necessity of routine thyroid evaluation in pediatric patients with ovarian cysts and precocious puberty. Early diagnosis and levothyroxine therapy can resolve symptoms and prevent invasive interventions, emphasizing the critical role of endocrinological assessment.

Keywords: Case report; Inguinal hernia; Juvenile hypothyroidism; Ovarian cysts; Van Wyk-Grumbach Syndrome.

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Conflict of interest statement

Conflict of interest statement We, the authors of this article, declare that we have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Contrast enhanced computed tomography (CECT) of the abdomen and pelvis showing multiloculated cystic lesion measuring 10 × 7.2 × 5 cm with internal septation possibly arising from the right ovary.
Fig. 2
Fig. 2
Intraoperative findings showing: an ischemic right ovarian mass with a cystic component (yellow arrow) and a left ovarian cyst.
Fig. 3
Fig. 3
Drainage and marsupialization of the left ovarian cyst wall.
See this image and copyright information in PMC

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