Please select the eligibility criteria that correspond to the clinical trial below.
Title: A Double-Blind, Randomized, Placebo-Controlled Trial of the Effect of Biosynthetic Growth Hormone and/or Ethinyl Estradiol on Adult Height in Patients With Turner Syndrome
Brief Summary: Turners Syndrome is a genetic condition in females that is a result of abnormal chromosomes. Girls with Turner syndrome are very short as children and as adults. Although their growth hormone secretion is almost always normal, giving injections of growth hormone to Turner syndrome girls may increase their rate of growth. In addition, most girls with Turner syndrome do not have normal ovaries.

In normal girls the ovaries begin producing small amounts of the female sex hormone, estrogen at about 11 - 12 years of age. As girls grow older the level of estrogen increases. Estrogen is responsible for the changes in girls known as feminization. During feminization the hips grow wider, the breasts develop, there is an increase in the rate of growth, and eventually girls experience their first menstrual period.

This study was designed to evaluate the effect of low dose estrogen, growth hormone, and the combination of low dose estrogen and growth hormone on adult height in girls with Turner syndrome. Patients will be entered into the study from ages 5 to 12 and will be randomly placed into one of four groups.

1. Group one will receive low dose estrogen
2. Group two will receive growth hormone
3. Group three will receive both low dose estrogen and growth hormone
4. Group four will receive a placebo "sugar pill"

Once started, the treatment will continue until the patients approach their adult height, and growth slows to less than 1/2 inch over the preceding year. This usually occurs by the age of 15 or 16.

Patients will be seen at the outpatient clinic every 6 months during the study and will receive a routine check-up with blood and urine tests, and hand/wrist X-rays to determine bone age. On patient's yearly visits they will have the density of bone measured in their spine and forearm.


Options:
A: Inclusion Criteria:

* Verified Turner syndrome
* Ages 10-25 years

Exclusion Criteria:

* Contraindications to the MR-scan
* Contraindications to the trial medication
* Severe or chronic sickness with impact on the parameters of the study or incompatibility with the trial medication
* Intake of medications with interactions with trial medication
B: INCLUSION CRITERIA

All subjects will be outpatients.

Patients must be females with Turner's syndrome diagnosed by leukocyte karyotype

Chronologic age greater than or equal to 5 years.

Prepubertal Tanner I status. If breast development is Tanner II or III, demonstration of castrate status through measurement of serum FSH (greater than 12 MIU/ML).

All patients must be below the 10th percentile for chronologic age.

Patients must have at least 6 months accurate, growth measurements available for calculation of pre-study growth velocity. Pretreatment measurements must be obtained during a time when the patient is not receiving a potential growth-promoting agent.

Patients judged to be thyroxine deficient must have replacement which has resulted in normal thyroid function tests over the three-month period prior to enrollment (T4, T3, Thyroid Stimulating Hormone).

Patients and/or parents or legal guardians of patients must sign an informed consent statement. Assent should be obtained from all patients competent to understand the protocol. Local IRB requirements apply.

EXCLUSION CRITERIA

Patients who have received any form of human growth hormone within the past 3 months, or who have received a cumulative course of therapy totaling greater than one year.

Patients who have received treatment with estrogen or androgen in the past three months or who have received a cumulative course of therapy totaling greater than one year.

Patients who have any Y component in their chromosome analysis.

Patients with a chronologic age greater than 12 years.

Patients with a bone age greater than 12 years.

Patients who have clinically significant cardiac, pulmonary, gastrointestinal, hepatic or renal disease or who have had any malignancy.

Patients who have significant hematuria or proteinuria in pretherapy evaluation.

Patients who have diabetes mellitus.

Patients who have any active chronic infection (tuberculosis).

Patients who are taking amphetamines or any other drugs known to interfere with growth hormone secretion or actions.

Patients who are poor medical, psychological, or psychiatric risks for whom, in the opinion of the principal investigator, the investigational drug would be unwise.

Patients whose parents are substance abusers, nor those who come from homes in which appropriate emotional development may be limited.

Patients who cannot be seen on the schedule required by the protocol.
C: Inclusion Criteria:

* Premature Ovarian Failure

Exclusion Criteria:

* Intercurrent illness
D: Inclusion Criteria:

* Girls with Turner Syndrome (45X, or related karyotypes) diagnosed clinically and cytogenetically
* Female subjects with Y material will be allowed providing gonadectomies have been performed previously
* Age: 13-20 years
* Subjects have completed or nearly completed their linear growth
* Previous growth hormone (GH) therapy discontinued at least 6 months prior to study participation
* Stable thyroid replacement therapy will be allowed
* Celiac disease on stable diets will be allowed
* Any previous hormone replacement therapy (HRT) will be allowed

Exclusion Criteria:

* Diabetes Mellitus on insulin therapy, insulin sensitizers or oral hypoglycemics
* Inflammatory Bowel Disease (ulcerative colitis or Crohn's disease), celiac disease
* Cigarette smoking
* Any other chronic conditions, that, in the opinion of investigators could impair the metabolism of nutrients
* Severe obesity, i.e., Body Mass Index (BMI) \>95th centile

Answer: B