The lack of sufficient GH causes a characteristic appearance (Fig. 14.19), with truncal obesity, a face appearing younger than the chronological age, and a tendency for crowding of the facial features to the centre of the face, suggesting maxillary hypoplasia. In boys, the genitalia may be small; however, a very small penis is suggestive of an associated gonadotrophin deficiency. Body proportions are normal before puberty, although these patients tend to have poorly developed musculature. Puberty, if it occurs spontaneously, is usually slightly, but not significantly, delayed.
