Vaginal bleeding: presenting symptom of acquired primary hypothyroidism in a seven year-old girl.

A seven year-old girl who presented with vaginal bleeding and a right ovarian cyst was diagnosed as having acquired primary hypothyroidism. She had menstruation in spite of a delayed bone age, absence of pubertal growth spurt and lack of adrenarche. Elevated levels (age-matched) of gonadotropins, normal levels of estradiol, and hyperprolactinemia were documented. The clinical and laboratory findings were reversed by thyroxin treatment. The clinical presentation in this case, and other similar descriptions in the literature, support the mechanism of pseudo-precocious puberty in untreated hypothyroidism.