Additional metabolic findings include low vitamin D/IGF-1α (Lv et al., 2019) and obesity (Hirakawa et al., 2017); SIDEs correlated with menstrual cycles in one report (Arslan et al., 2014); hirsutism was observed in a female patient (Haspeslagh et al., 1984). Here, IGF1 is linked to obesity due to melanocortin 4 receptor deficiency.