Similar growth restriction syndromes characterized by adrenal insufficiency, FGR and other features, include IMAGe syndrome (intrauterine growth restriction, metaphyseal dysplasia, adrenal hypoplasia, genitourinary anomalies), caused by gain-of-function variants in the cell-cycle repressor CDKN1C (54, 55), and “IMAGe-like” syndrome with immunodeficiency, caused by biallelic variants in the DNA polymerase POLE1 (56). Here, POLE is linked to Metaphyseal dysplasia.