Other reported features potentially associated with POMC deficiency include pale skin (Fitzpatrick type 1) due to reduced stimulation of MC1R by MSH; central hypothyroidism, possibly due to interactions between POMC and thyrotropin-releasing hormone in the hypothalamus (10,11,12,13); and hypogonadotropic hypogonadism with pubertal growth hormone deficiency reflecting a possible direct interaction between POMC and gonadotropin-releasing hormone neurons or indirectly via kisspeptin and NPY/AgRP. Here, NPY is linked to hypogonadotropic hypogonadism.