PMC3184518_01
Figure 1. Patients 1 (A), 2 (B), 3 (C) and  4 (D). The patients exhibited the physical findings of  3M syndrome: Dolichocephaly, high and broadforehead, upswept posterior hairline (in patients 1 and 2), downward slanting of the eyes, horizontal eyebrows, flat nasal bridge, narrowed and short nasal body, prominent fleshy nasal tip, straight clavicles, high and square shoulders, short, wide and flat thorax with a mild pectus excavatum
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The skeletal dysplasia was not considered at genetic evaluation at age 9 and GH  therapy was recommended.  GHIS was excluded with IGF-1 generation test (Table 3).   The patient's anthropometric and physical examination findings are given in Table 1 and in Figures 1C, 2B and 6.
Figure 2. Exaggerated hyperlordosis as seen in Patients  1 (A) and  3(B)
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Radiographic bone survey showed slender long bones with  diaphyseal constriction and flared metaphyses, slender ribs, thick cortex of the tibia and femur, tall lumbar vertebrae, a small pelvis, short femoral neck and short iliac wings ([tif:Figure 3. Lateral radiography of the vertebrae showing tall vertebral bodies with reduced anterior-posterior diameters (Patient 1)|9-3.tif]Figures 3[/tif] and [tif:Figure 4.
Figure 5. Radiography of the lower extremity and lateral vertebrae in Patient 2
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Lateral radiography of the vertebrae showing tall vertebral bodies with reduced anterior-posterior diameters (Patient 1)|9-3.tif]Figures 3[/tif] and [tif:Figure 4.
Figure 6. Prominent heels were present  in all patients
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Skeletal  survey showed slender long bones with diaphyseal  constriction and flared metaphyses, slender ribs, tall lumbar vertebrae, small pelvis and short iliac wings (Figure 5).
PMC3184518_02
Figure 1. Patients 1 (A), 2 (B), 3 (C) and  4 (D). The patients exhibited the physical findings of  3M syndrome: Dolichocephaly, high and broadforehead, upswept posterior hairline (in patients 1 and 2), downward slanting of the eyes, horizontal eyebrows, flat nasal bridge, narrowed and short nasal body, prominent fleshy nasal tip, straight clavicles, high and square shoulders, short, wide and flat thorax with a mild pectus excavatum
JCRPE-3-154-g1.jpg
PMC3184518_02_JCRPE-3-154-g1.jpg
fg2
The skeletal dysplasia was not considered at genetic evaluation at age 9 and GH  therapy was recommended.  GHIS was excluded with IGF-1 generation test (Table 3).   The patient's anthropometric and physical examination findings are given in Table 1 and in Figures 1C, 2B and 6.
Figure 7. Note the narrow pelvis, hypoplastic pubis and ilium, as well as the short femoral necks (Patient  3)
JCRPE-3-154-g5.jpg
PMC3184518_02_JCRPE-3-154-g5.jpg
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The skeletal dysplasia was not considered at genetic evaluation at age 9 and GH  therapy was recommended.  GHIS was excluded with IGF-1 generation test (Table 3).   The patient's anthropometric and physical examination findings are given in Table 1 and in Figures 1C, 2B and 6.
Figure 1. Patients 1 (A), 2 (B), 3 (C) and  4 (D). The patients exhibited the physical findings of  3M syndrome: Dolichocephaly, high and broadforehead, upswept posterior hairline (in patients 1 and 2), downward slanting of the eyes, horizontal eyebrows, flat nasal bridge, narrowed and short nasal body, prominent fleshy nasal tip, straight clavicles, high and square shoulders, short, wide and flat thorax with a mild pectus excavatum
JCRPE-3-154-g6.jpg
PMC3184518_02_JCRPE-3-154-g6.jpg
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Skeletal survey of the patient showed slender long bones with diaphyseal constriction and flared metaphyses, slender ribs, thick cortex in the tibia and femur, short femoral neck, tall lumbar vertebrae, small pelvis and short iliac wings (Figure 7). 
PMC3184518_03