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Picture of the Month—Diagnosis
Arch Pediatr Adolesc Med. 2008;162(11):1092.
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Denouement and Discussion: Osteoma Cutis Associated With Pseudohypoparathyroidism Type 1a
The radiograph of the lower extremity lesion (Figure 2) showed microcalcifications limited to the subcutaneous region. The biopsy specimen (Figure 3) revealed mature lamellar bone limited to the epidermis and dermis, diagnosed as osteoma cutis. In light of these findings, as well as physical features of round facies and poor growth, a diagnosis of pseudohypoparathyroidism type 1a (PHP1a) was considered. Results of laboratory examination to explore potential associated endocrine abnormalities revealed an elevated thyrotropin (TSH) level of 8.82 mIU/L (reference range, 0.27-4.2 mIU/L), a normal free thyroxine level of 1.520 ng/dL (reference range, 1.01-1.79 ng/dL) (to convert to picomoles per liter, multiply by 12.871), and normal calcium, phosphorous, and parathyroid hormone levels. The child started thyroid hormone therapy.
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Figure 2. A radiograph of the left ankle demonstrates subcutaneous, radio-opaque lesions (arrows).
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Figure 3. A photomicrograph demonstrates mature lamellar bone (arrows) in the epidermis and dermis (hematoxylin-eosin).
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. . . [Full Text of this Article]
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