Patient case (clinical description): A 9-year-old girl is brought to the office for evaluation of short stature and overweight body habitus. The patient's mother and father are 170 cm and 181 cm tall, respectively.  On physical examination, the patient's height is in the 5th percentile of her age.  Other findings include low-set ears, a high arched palate, a webbed neck, and cubitus valgus.  Chromosomal analysis reveals a 45, XO karyotype.

Patient's own account: I took my 9-year-old daughter to the doctor because my mother-in-law kept saying she seemed small and overweight. My husband and I are 170 cm and 181 cm tall, respectively. The physical health highlighted that she is in the 5th percentile of her age. The doctor said that she has low-set ears, a high-arched palate, a webbed neck, and cubitus valgus. She also did a chromosomal analysis, which revealed a 45, XO karyotype.

Clinical trial: Safety and Efficacy Phase 3 Study of Long-acting hGH (MOD-4023) in Growth Hormone Deficient Children

Eligibility criteria:
Main Study Inclusion Criteria:

          1. Pre-pubertal children aged ≥3 years , and not yet 11 years for girls or not yet 12
             years with either isolated GHD, or GH insufficiency as part of multiple pituitary
             hormone deficiency.

          2. Confirmed diagnosis of GHD by two different GH provocation tests defined as a peak
             plasma GH level of ≤10 ng/mL,

          3. Bone age (BA) is not older than chronological age and should be less than 10 for girls
             and less than 11 for boys.

          4. Without prior exposure to any r-hGH therapy (naïve patients).

          5. Impaired height and height velocity defined as:

               -  Annualized height velocity (HV) below the 25th percentile for CA (HV < -0.7 SDS)
                  and gender according to sponsor calculator using Tanner, Prader, and Hermanussen

               -  The interval between 2 height measurements should be at least 6 months, but
                  should not exceed 18 months prior to inclusion

          6. Baseline IGF-I level of at least 1 SD below the mean IGF-1 level standardized for age
             and sex (IGF-1 SDS ≤-1)

          7. Normal calculated GFR per updated bedside Schwartz formula

          8. Children with multiple hormonal deficiencies must be on stable replacement therapies
             (no change in dose) for other hypothalamo-pituitary-organ axes for at least 3 months
             prior ICF signing

          9. Normal 46XX karyotype for girls.

         10. Provide consent/assent

             LT-OLE Inclusion Criteria:

         11. Completion of the main study (12 months of treatment) with adequate compliance.

         12. Provide consent/assent

         13. Agree to refrain from sexual activity

        Main Study Exclusion Criteria:

          1. Children with prior history of leukemia, lymphoma, sarcoma or any other forms of
             cancer.

          2. History of radiation therapy or chemotherapy

          3. Malnourished children defined as BMI < -2 SDS for age and sex

          4. Children with psychosocial dwarfism

          5. Children born small for gestational age (SGA - birth weight and/or birth length <-2
             SDS for gestational age)

          6. Presence of anti-hGH antibodies at screening

          7. Any clinically significant abnormality likely to affect growth or the ability to
             evaluate growth, such as, but not limited to, chronic diseases like renal
             insufficiency, spinal cord irradiation, etc.

          8. T2 and T1 diabetic patients, who in the opinion of the investigator are not receiving
             standard of care treatment or are non-compliant with their prescribed treatment or who
             are in poor metabolic control.

          9. Chromosomal abnormalities including Turner's syndrome, Laron syndrome, Noonan
             syndrome, Prader-Willi syndrome, Russell-Silver syndrome, SHOX mutations/deletions and
             skeletal dysplasias.

         10. Concomitant administration of other treatments that may have an effect on growth such
             as anabolic steroids, or sex steroids, with the exception of ADHD drugs or HRT
             (thyroxin, hydrocortisone, desmopressin)

         11. Children requiring glucocorticoid therapy (e.g. for asthma) that are taking
             chronically a dose greater than 400 μg/d of inhaled budesonide or equivalent

         12. Major medical conditions and/or presence of contraindication to r-hGH treatment.

         13. More than one closed epiphyses

         14. Known or suspected HIV-positive patient, or patient with advanced diseases such as
             AIDS or tuberculosis.

         15. Drug, substance, or alcohol abuse.

         16. Known hypersensitivity to the components of study medication.

         17. Other causes of short stature such as celiac disease, uncontrolled primary
             hypothyroidism and rickets.

         18. Possible non-compliance in respect to study conduct

         19. Participation in any other trial of an investigational agent within 30 days prior to
             consent

         20. Study enrollment has been met or study is closed by sponsor prior to completion of
             screening process.

             LT-OLE Exclusion Criteria:

         21. Concomitant administration of other treatments that may have an effect on growth such
             as anabolic steroids, or sex steroids, with the exception of ADHD drugs or HRT
             (thyroxin, hydrocortisone, desmopressin)

         22. Change in medical condition during the treatment period (such as, but not limited to,
             development of a serious inter-current critical illness, a severe adverse drug
             reaction, etc.)

         23. Positive pregnancy test

         24. Unresolved drug related (Genotropin or MOD-4023) SAE from the treatment period as per
             medical monitor judgement.
No condition on gender to be admitted to the trial.
No healthy subjects accepted to join the trial.
Subject must be at least 3 Years old.
Subject must be at most 11 Years

Eligibility (NLI label): Contradiction