IMAGe syndrome (intrauterine growth restriction, metaphyseal dysplasia, adrenal 
hypoplasia congenita, genital abnormalities; MIM 300290) is a multisystem 
disorder with a broad phenotype, which, if unrecognized, may result in major and 
possibly life-threatening complications. Initial clinical features overlap with 
those of Russell-Silver syndrome (RSS) and isolated growth hormone (GH) 
deficiency, conditions from which it must be distinguished. We report an 
Australian male with adrenal hypoplasia congenita (AHC) in association with 
IMAGe syndrome. The patient had intrauterine growth restriction (IUGR) and 
dysmorphic features comprising small, low-set ears, micrognathia, bilateral 
cryptorchidism, micropenis, and skeletal abnormalities. Signs of adrenal 
insufficiency occurred at aged 4.6 years. Our patient differs from those 
previously described by the late onset of adrenal insufficiency and the presence 
of GH deficiency. IMAGe is a complex syndrome involving dysmorphic features; 
disorders of growth, gonadal, and adrenal function; and skeletal abnormalities.