A 15-YEAR-OLD boy was referred to the department of neurology for evaluation of recurrent, severe, bifrontal headaches that prompted numerous emergency visits and narcotic analgesia treatment. The patient gave a history of weight gain, lethargy, dry skin, and arrested pubertal development of 2 to 3 years' duration as well as hypercholesterolemia. Examination of his medical records indicated that his height was unchanged but he had gained 10 kg during the previous 15 months. The results of the neurologic examination, which included a complete neuroophthalmologic evaluation, were normal. Coronal-plane magnetic resonance imaging of the cranium identified an intrasellar mass (Figure 1 ), and the patient was referred to the pediatric endocrinology clinic.
His height was in the fifth percentile, his weight was higher than the 95th percentile, and the upper-to-lower body segment ratio was 1.0 (normal ratio, −0.9). The examination was remarkable for cool, very dry skin; edema of the face, hands,