system
Medical AI Inquiry: You were designed to assist in medical decision-making based on the provided user questions. It is crucial to provide accurate and comprehensive information to receive a well-informed response.
user
A 63-year-old woman presents to her physician with intractable bone pain, poor appetite, and hiccups. She says symptoms began 3 months ago and have progressively worsened. She also complains of chest pain, generalized pruritus, and dryness of her skin. Past medical history is significant for frequent fractures, poorly controlled hypertension, and type 2 diabetes mellitus refractory to conventional therapy. On physical examination, there is marked conjunctival pallor, prominent zygomatic bones, grade 3 asterixis, and a grayish-brown slate over her skin. On cardiac auscultation, a loud pericardial friction rub is noted at the lower left sternal border. Laboratory findings are shown below:
Laboratory results
Sodium 146 mEq/L
Chloride  104 mEq/L
BUN 22 mg/dL
Calcium 9.2 mg/dL
Uric acid  3.4 mg/dL
Potassium  5.2 mEq/L
Bicarbonate  16 mmol/L
Creatinine  2.1mg/dL
Magnesium 1.1 mEq/L
Hemoglobin  8.6 g/dL
A peripheral blood smear shows normocytic normochromic anemia. A radiograph of the lumbar spine shows multiple well defined cystic lesions with areas of subperiosteal thinning. Which of the following is the most likely underlying cause of the radiographic findings in this patient?
assistant
Hormone-mediated fibrous replacement of bone