GH1 and obesity due to melanocortin 4 receptor deficiency: In obesity, the spontaneous (197, 198) and stimulated (199) pulsatile patterns of GH secretion governed by the hypothalamus are blunted, and the accumulation of abdominal adiposity, particularly visceral adipose tissue mass, was found to be a stronger negative determinant of GH secretion than other factors including age, sex, or generalized obesity (200–202).