Clinical features of the patients. (a) Case 1. Absence of subcutaneous fat, muscular hypertrophy, marked umbilical prominence, large hands and feet, enlarged liver and spleen. (b, c) Case 3. Hypertrophy of skeletal muscles, enlarged liver and spleen. (d) Case 4. Mild generalized loss of subcutaneous fat and muscular stature, marked umbilical prominence. (e) Case 6. Acromegalic appearance, protruding abdomen, marked umbilical prominence, velvety thickening and hyperpigmentation of the skin around neck, in axillae and antecubital fossae (acanthosis nigricans).