IGF1 and metabolic process: Growth and development: Growth faltering, short stature, GH resistance, and persistently low IGF-1 levelsHand, feet, and MSK: Bilateral coxa valga, mild scoliosis, hyperlaxity of the upper limb, clinodactyly of the fifth finger bilaterally, shortening of the third toe bilaterally, persistent fetal pads, and palmar crease on the right handCraniofacial: Malar hypoplasia, high arched palate, microstomia, long philtrum, proptosis, and retrognathiaCardiac and other: Seizures and ketotic hypoglycemic episodes with high AG metabolic acidosis, closed atrial septal defect