Other Endocrine Affection
Acquired Infantile Hypothyroidism. During childhood, the onset of signs of hypothyroidism may be very insidious and they may follow their course for several months before diagnosis. Some pictures are atypical. Gordon et al.

described the case of a girl with metrorrhagia associated with rapid pubertal development. Pelvic ultrasonography showed large polycystic ovaries.

Percutaneous aspiration of the ovarian cysts together with the institution of thyroid replacement therapy led to regression of the cysts and pubertal signs.

The same anomalies have been described in the adult with bilateral ovarian cysts. In this case, they are due to interaction between elevated TSH levels and the ovarian FSH receptor.

Adrenal Disorder. Excessive steroid production by the adrenal glands may stimulate small ovarian cysts to develop into large cysts capable of causing gonadotropin-independent precocious puberty, as has been reported in young girls with rapid sexual development. The signs decrease with cyst removal.

However, serum 17-hydroxyprogesterone responses to ACTH seem to be in favor of non-classical forms of 21-hydroxylase deficiency. The pathogenic hypothesis is that the adrenal gland might be the source of the increase in steroid sulfates (SDHA). In turn, these steroids could be converted into estrogens by the small follicular cysts that occur as a normal developmental process.

Estrogen could stimulate cyst growth and increased gonadotropin-independent estrogen production.