A nurse is reinforcing teaching with a child and her parents who has a growth hormone deficiency. Which of the following complications of untreated growth hormone deficiency should the nurse include? (Select all that apply.)

A. Growth hormone (GH) deficiency does not cause early closure of the epiphyseal plates. Instead, GH deficiency results in delayed epiphyseal closure due to slowed skeletal growth. B. Children with untreated GH deficiency may develop features of premature aging, including decreased muscle mass, increased fat distribution, and reduced energy levels as they grow older. This results from long-term metabolic effects of inadequate GH. C. GH deficiency often occurs along with other pituitary hormone deficiencies. This can result in delayed puberty, delayed sexual maturation, and lack of secondary sexual characteristics. D. Short stature is the most prominent complication of untreated GH deficiency. Children grow at a reduced rate and fall below the expected growth curve without GH supplementation. E. GH deficiency leads to delayed (not advanced) bone age due to impaired skeletal maturation. Radiographs usually show younger-than-expected bone development for the child’s chronological age.