presented an 11-year-old patient with P4B3-4 Tanner stage, obesity with elevated fasting insulin, thyroid peroxidase antibodies and prolactin, and proposed that the dysfunction of the pituitary cells which control hormone release is a likely cause for dysregulation of the hypothalamic pituitary axis (15). This evidence concerns the gene INS and obesity due to melanocortin 4 receptor deficiency.