A 32-year-old man presents with short stature, bilateral cataracts (diagnosed at age 28), premature graying of hair, sclerodermatous skin changes, chronic ankle ulcers, hypogonadism, type 2 diabetes mellitus, and osteoporosis. His pedigree shows an affected sister and an unaffected brother born to unaffected parents who are first cousins. The inheritance pattern shown at position **B** in the diagram best describes this family. Which of the following is the most likely diagnosis?
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