A five year old girl is brought to a pediatrician because she is developing breasts. Physical examination shows large hyperpigmented macules with irregular margins on one side of her back. Which of the following bony abnormalities would most be likely associated with these symptoms?
McCune-Albright syndrome is the combination of precocious sexual development, irregularly shaped ("coast of Maine") pigmented skin macules, and polyostotic fibrous dysplasia. The latter condition is characterized by local bony defects containing unmineralised whorls of connective tissue. Renal osteodystrophy refers to a constellation of bony changes occurring in the context of chronic renal failure. Features may include those of osteitis fibrosa cystica (marrow fibrosis, bony resorption and cyst formation within the marrow cavity) and osteomalacia. Osteomalacia results from vitamin D deficiency in adults, and is characterized by a generalized thinning of bony spicules. Osteopetrosis is characterized by excessive bony deposition that can obliterate marrow , causing anemia. Ref: Bauman D. (2013). Chapter 37. Pediatric & Adolescent Gynecology. In A.H. DeCherney, L. Nathan, N. Laufer, A.S. Roman (Eds), CURRENT Diagnosis & Treatment: Obstetrics & Gynecology, 11e.
A combination of osteitis fibrosa cystica and osteomalacia
A generalized thinning of bony spicules
Excessive bony deposition with obliteration of marrow
Multiple localized whorls of connective tissue