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4 PWS is a complex multisystem disorder, characterized by neonatal hypotonia and feeding difficulties in early infancy, short stature, behavioral problems, cognitive impairment, psychiatric illness, dysmorphic features (characteristic facial appearance, small hands and feet, narrow hands with straight ulnar border, scoliosis), multiple endocrine abnormalities (hypogonadism, growth hormone [GH]/insulin-like growth factor-I axis dysfunction, hypothyroidism, central adrenal insufficiency), early development of hyperphagia with food seeking behavior, and progressive development of severe obesity, unless eating is not promptly restricted