Medical history The parents of a 3-year and 8-month-old male child, presented to a medical appointment complaining of aggressive behavior, growth of pubic hair, enlarged penis and episodes of penile erection. Physical examination: 50.9 kg (112,22 lb.) of weight (z-score: > +3), 119,5 cm (3ft and 11 in) of height (z-score: > +3). Presence of hyperpigmented skin spots on the patient’s neck, hands and buttocks and significant testicular asymmetry (left: 8 ml, right: 25 ml). Previous exam results were brought: FSH < 0.66 mIU/mL (RV: 1.55-9.74 mIU/mL), LH < 0.216 MLU/mL (RV: 0.833-15.5 mIU/mL), total testosterone 327.0 ng/dL (RV 20 to 49 years: 132-813 ng/dL). Radiographic and scintigraphic evaluations were also performed and their results are herein attached. Photograph of the patients anterolateral cervical regionRadiograph of the patients left hand with the forearm in supination (external rotation) obtained when the child was 2-years and 8-months-oldBone scintigraphy with 99mTc-MDP performed when the patient was 3-years and 5 months-old Question:According to the clinical history and the images presented, which is the most likely diagnosis? Congenital adrenal hyperplasia Precocious puberty of central origin Neurofibromatosis Type 1 McCune-Albright syndrome Time is Up! Time's up
