Patient description: A 12 year old girl came to the clinic with her mother, complaining of short stature, delayed in puberty and developmental delay. Her karyotype study revealed 45X and confirmed the diagnosis of Turner syndrome. She is treating with GH since 6 months ago without estrogen therapy to avoid menarche and reach the ideal height. She is an obese, mentally retarded girl in the physical exam. Her breast bulb were in stage 1 with no course hair in the pubic or axillary. Her TSH was 3 and FBS was 75 in the latest lab study.

Clinical trial eligibility criteria: eligible ages (years): 0.0-17.0,  Growth Hormone Disorder Growth Hormone Deficiency in Children Cohort I Boys: Tanner stage 1 for pubic hair and testis volume below 4 ml , age at least 2 years and 26 weeks and below or equal to 10.0 years at screening Girls: Tanner stage 1 for breast development (no palpable glandular breast tissue) and pubic hair, age at least 2 years and 26 weeks and below or equal to 9.0 years at screening Confirmed diagnosis of GHD (growth hormone deficiency) within 12 months prior to screening as determined by two different GH (growth hormone) stimulation tests, defined as a peak GH level of below or equal to 7.0 ng/ml. For children with three or more pituitary hormone deficiencies only one GH stimulation test is needed No prior exposure to GH therapy and/or IGF-I (insulin-like growth factor I) treatment Height of at least 2.0 standard deviations below the mean height for chronological age (CA) and gender according to the standards of Centers for Disease Control and Prevention 2-20 years: Girls/Boys stature-for-age and weight-for-age percentiles CDC at screening Annualized height velocity (HV) below the 25th percentile for CA (chronological age) and gender or below -0.7 SD (standard deviation) score for CA and sex, according to the standards of Prader calculated over a time span of minimum 6 months and maximum 18 months Cohort II Below 2 years and 26 weeks and a minimum weight of 5 kg at screening Confirmed diagnosis of GHD, the GHD diagnosis must be confirmed by investigator according to local practice For GH treatment naïve subjects, no prior exposure to GH therapy and/or IGF-I treatment  Any clinically significant abnormality likely to affect growth or the ability to evaluate growth with standing/length measurements: Chromosomal aneuploidy and significant gene mutations causing medical "syndromes" with short stature, including but not limited to Turner syndrome, Laron syndrome, Noonan syndrome, or absence of GH receptors. Congenital abnormalities (causing skeletal abnormalities), including but not limited to Russell-Silver Syndrome, skeletal dysplasias. Significant spinal abnormalities including but not limited to scoliosis, kyphosis and spina bifida variants Children born small for gestational age (SGA birth weight and/or birth length below-2 SD for gestational age) Concomitant administration of other treatments that may have an effect on growth (not applicable to non-GH treatment naïve subjects in cohort II and III), including but not limited to methylphenidate for treatment of attention deficit hyperactivity disorder (ADHD) Prior history or presence of malignancy and/or intracranial tumour