POMC and hyperinsulinemic hypoglycemia, familial, 4: However, low-grade OPGs affecting the hypothalamus and suprasellar areas may evolve over decades and present with GH deficiency (40.3%), central precocious puberty (26.0%), gonadotropin (20.4%), TSH (13.3%), and ACTH (13.3%) deficiency [56,57,58], or GH excess (10%) [14].