PMC8294969_01
(a) Height chart (red dot: target height; green dot: twin's height; black dots: patient's height curve). (b) BMI chart (black dots: patient's BMI curve) of the patient showing shifting of Z-scores after an age of 13 years.
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fig1
On physical examination, the patient had normal vital signs; generalized cachexia, facial lanugo hair, and cutaneous xerosis; Russell's sign was noted in his third left finger; height was 155.5 cm (-2.5 SD; target height: 168.9 cm, -1.1 SD), weight was 30.2 kg, and BMI was 12.5 kg/m2 (-6.8 SD); his height chart showed a progressive decrease in his linear growth, markedly (height velocity: 2.7 cm/year) after an age of 13 years (see Figure 1(a)); his BMI chart paralleled the height chart (see Figure 1(b)); the left and right testis measured 8 mL and 10 mL, respectively (Tanner stage: G3P3).