Effect of Growth Hormone on Early Brain Development in Girls With Turner Syndrome

Studies in older children and adults have found that IQ in individuals with Turner syndrome
(TS) and the general population are similar. However, many individuals with TS have a
nonverbal learning disability which may cause problems with imagining and working with
objects in space (for example: building blocks, working puzzles, copying designs, driving a
car) as well as problems in planning, paying attention, and getting along with people their
own age. Studies of brain structure have found changes in the size and function of specific
areas of the brain that are involved in these nonverbal processes. However, there are no
data published on brain structure or function in girls with Turner Syndrome in the first few
years of life when brains are learning and growing most rapidly.

In a recent study, very young, short girls with Turner Syndrome (TS)(averaging 2 years in
age) were treated with Growth Hormone (GH) and almost reached an average height after 2
years. The risks of GH for the young girls in that study appeared to be the same as those
for older girls. Therefore, it is now recommended that GH therapy be considered as soon as a
child with TS has growth failure. Growth failure often occurs during infancy; therefore,
more children with TS are now receiving GH therapy as young as 12 months of age. In this
study, the investigators wish to start understanding what effect GH has on learning and
brain growth when given between the ages of 12 and 24 months. In this study, the girls with
TS will have developmental studies, a physical examination, magnetic resonance imaging
(MRI), and blood drawn at one and two years of age. Some of the girls in this study will
receive GH from 12 until 24 months of life, while others will not. Brain growth and
development will be compared between those who have been treated with GH and those who have
not. This is a pilot study in which the investigators will gather data to design a larger
study that can answer these questions.

Inclusion Criteria:

- Diagnosis of Turner syndrome

- Less than the 50th percentile for length for the general female population

Exclusion Criteria:

- Prior Growth Hormone (GH) therapy

- Diabetes

- Allergy to metacresol (a preservative in the GH liquid that is injected)

- Contraindications for Magnetic Resonance Imaging (MRI) (such as metal in the body)

- Part of a Y chromosome in child's karyotype

- Parent/guardian is not willing for child to be randomized to be in the treatment
group (receives Growth Hormone injections for one year) or the control group
(receives no Growth Hormone during the study)

- Parent/guardian is not willing for child to have some of her developmental testing
digitally recorded for scoring