After more than 20 yr, leukemia, a major safety issue initially believed associated with GH, has not been confirmed, but other signals, including risk of second malignancies in patients previously treated with irradiation, have been detected or confirmed through the NCGS. These data further clarify the events associated with rhGH and, although confirming a favorable overall safety profile, they also highlight specific populations at potential risk.
Turner syndrome occurs in 1 of every 2000 to 5000 live female births and is now recognized to encompass a broad range of chromosomal karyotypes and clinical phenotypes. Many of these individuals appear completely normal save for their short stature. This article reviews the major clinical and physiologic abnormalities that can occur and places special emphasis on the problems of short stature and gonadal failure. Evidence is reviewed that indicates that there is a potential for increased height with growth hormone treatment. Also discussed is the spectrum of gonadal function, ranging from the onset of spontaneous puberty and the potential for fertility to complete gonadal failure.
Using baseline age- and gender-specific targets will assist clinicians in assessing a patient's first-year growth response. We propose that HV below the mean - 1 sd on these plots be considered a "poor" response. These curves may be used to identify patients who may benefit from GH dose adjustment, to assess compliance issues, or to challenge the original diagnosis.
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