Approach to precocious puberty Quiz: Ace Your Exams

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A 3-year-old girl is brought to the office for vaginal bleeding for three days and mucosal vaginal discharge for one week. The patient was born at full term with normal delivery to non-consanguineous parents. The patient has a history of multiple fractures. She has no surgical history, and she does not take any daily medications. Temperature is 37°C (98.6°F), pulse is 95/min, respirations are 22/min, blood pressure is 100/66 mm Hg. Weight is at 95th percentile for age, height is at 60th percentile for age, and head circumference is at 66th percentile for age. Skin examination reveals the skin lesions shown below. Breast development is at Tanner stage II and pubic and axillary hair is at Tanner stage I and female genitalia with signs of maturation. Abdominal and cardiopulmonary exams are unremarkable. Labs show elevated growth hormone levels and prepubertal levels of gonadotropins. X-ray of the femur shows cortical thinning and ground-glass radiolucency. Which of the following is the most likely cause of this patient’s vaginal bleeding?
 
McCune-Albright syndrome” by Claudia E Dumitrescu, Michael T Collins. Orphanet Journal of Rare Diseases. 3, 12. 2008. Licensed under CC BY 2.0. Reproduced from Wikipedia. 

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