A complex case of McСune—­Albright syndrome in a war-­affected child: a clinical challenge in times of crisis

We present a complex clinical case of McCune­—Albright syndrome (MAS) in a 9­-year­-old girl from Kherson, Ukraine, whose diagnosis and treatment were delayed due to the war. The patient first showed café­-au-­lait macules at 2.5 months of age, and since then she has been seen by an endocrinologist and receiving treatment, but due to the occupation of her city in 2022 and ongoing hostilities, she remained without medical care for over a year. At 9 years and 7 months, she was referred to a specialized center in Kyiv. Clinical findings included asymmetrical café­-au-­lait spots, Tanner stage Ax4P4Ma2, advanced bone age (14 years), and a history of low-­trauma fractures. Laboratory tests revealed elevated estradiol, suppressed gonadotropins, increased IGF­-1, prolactin, and ALP. Pelvic ultrasound confirmed autonomous ovarian function, while bone scintigraphy showed multiple foci of fibrous dysplasia. DXA revealed within normal limits for bone mineral density. MAS was diagnosed based on the classic triad: fibrous dysplasia, café­-au-­lait macules, and peripheral precocious puberty. Treatment included cyproterone acetate, alphacalcidol, calcium, and vitamin D. A long-term manage­ment plan was initiated with regular hormonal and imaging follow-­up, orthopedic care, physiotherapy, and psycholo­gical support. This case highlights not only the complexity of MAS but also the devastating effects of disrupted healthcare in wartime. It emphasizes the importance of early diagnosis, multidisciplinary support, and international cooperation to ensure continuity of care for children with rare endocrine diseases. Even in war, no child should be left without care.