Crossover sites resulting from unequal recombination within the human growth hormone (GH) gene cluster that cause GH1 gene deletions and isolated GH deficiency type 1A were localized in nine patients. In eight unrelated subjects homozygous for 6.7-kilobase (kb) deletions, the breakpoints are within two blocks of highly homologous DNA sequences that lie 5' and 3' to the GHI gene. In seven of these eight cases, the breakpoints map within a 1250-base-pair (bp) region composed of 300-bp Alu sequences of 86% homology and flanking non-Alu sequences that are 600 and 300 bp in length and are of 96% and 88% homology, respectively. In the eighth patient, the breakpoints are 5' to these Alu repeats and are most likely within a 700-bp region of 96% homologous DNA sequences. In the ninth patient homozygous for a 7.6-kb deletion, the breakpoints are contained within a 29-bp perfect repeat lying 5' to GH1 and the human chorionic somatomammotropin pseudogene (CSHPI). Together, these results indicate that the presence of highly homologous DNA sequences flanking GHI predispose to recurrent unequal recombinational events presumably through chromosomal misalignment.Familial isolated growth hormone deficiency (IGHD) type 1A is characterized by complete absence of growth hormone (GH) frequently but not always associated with immune intolerance to exogenous GH (1-3). This disorder has an autosomal recessive mode of inheritance and affected individuals are homozygous for deletion of the DNA encompassing the structural gene for growth hormone (GHI). GH1 is normally present at the 5' end of the 48-kilobase (kb) human GH gene cluster, which 5' -> 3' contains GHJ, CSHPI, CSHI, GH2, and CSH2. These genes map to chromosome 17q22-24 and retain 92-98% homology in their immediate flanking, intervening, and coding sequences (4-6). Although heterogeneity exists with regard to the sizes of the deletions, most (8/10) of those independently ascertained and characterized in our laboratory are =6.7 kb in length, whereas some (2/10) are slightly larger, spanning 7.6 kb (7). Only the GHJ locus was deleted in each and the remaining components of the cluster appeared intact. However, Goossens et al. (8) have reported that the DNA from one IGHD 1A patient was homologous for a double deletion in which the only component of the GH gene cluster retained was the chorionic somatomammotropin pseudogene CSHPL. Homozygosity for deletions encompassing the genes for CSHJ or CSHI-GH2-CSH2 has also been reported in phenotypically normal individuals (9, 10).We have previously reported that differences observed in restriction fragment length polymorphisms (RFLPs) flanking remaining components of the GH gene cluster suggest that most deletions resulted from independent deletion events (7 Restriction Endonuclease Analysis. High molecular weight nuclear DNA was isolated as described (22) from peripheral blood samples (10-20 ml) obtained from patients with IGHD type 1A and their relatives. Aliquots (5 pug) of DNA were digested with various restriction endonucleases...