On physical examination, he had rounded facies, dry skin, loss of the lateral third of his eyebrows, coarse hair, low-pitched voice, macro-orchidism, and a waddling gait. He did not have goiter, proximal myopathy, or a delayed relaxation phase of deep tendon reflexes. He was extremely short for his age. His height of 108.8 cm (SD score, −4.54) was also significantly lower than his parental target centile range of 151 cm (SD score, −3.53) to 171 cm (SD score, −0.79). His bone age was delayed at 2 years. Radiographs of the left hip (Figure 1) and the hand, lower limbs, spine, and skull (Figure 2) were obtained.