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Turner Syndrome, or TS, affects about 1 of every 2,500 live female births. Although some girls with TS may show outward signs of the condition, others may not.

Outward signs of TS may include:

• Short stature
• Webbing of the neck
• Low-set, rotated ears
• Arms that turn out slightly at the elbows
• Low hairline at the back of the head

Internal signs of TS may include:

• Not reaching sexual maturity or starting a menstrual period
• Joint and bone problems
• Thyroid problems
• Abnormal swelling
• Kidney problems
• Heart problems
• Repeated ear infections
• Infertility
• A high, arched palate in the mouth

How growth hormone (GH) works in your body

Made by the pituitary gland in the brain, growth hormone helps the body produce muscle and break down fats. It also plays a critical role in helping young bodies grow and develop. When levels of growth hormone are too low, there's an impact on many things the body does—including development and growth.

How TS happens

TS is caused by loss of part or all of one X chromosome in some or all cells of the body. Even though it’s rare, TS is the most common condition affecting the female sex chromosome.

How TS is diagnosed

TS is discovered shortly after birth. A blood test called a karyotype is used to find the affected female sex chromosome that identifies TS.

Girls with TS may not need to be tested for an hGH deficiency because their hGH levels are typically normal. But poor long bone and spinal column growth lead to short stature and growth failure in nearly 100% of girls with TS. GH treatment may help improve bone growth in girls with TS.

How growth failure associated with TS may be treated

Back in the 1930s, when Dr. Henry Turner first described the condition, there were no treatments for growth failure associated with TS. And while there is still no cure, there are treatments that may help manage growth failure.

TS affects girls in many ways, and may require treatment from several specialists. Girls with TS should have their height checked regularly and plotted on a TS modified growth chart.

For girls with TS:

• GH treatment may be most beneficial when started soon after diagnosis
• Since estrogen promotes puberty, estrogen replacement therapy may be prescribed
• Doses may be adjusted by your healthcare professional based on how well your daughter is growing
• Your healthcare professional may continue GH therapy until it’s appropriate to stop

Girls with TS should also be checked regularly for:

• Ear and hearing problems
• Cardiovascular disorders such as aortic dissection, stroke, aortic aneurysm, or high blood pressure
• Scoliosis

IMPORTANT SAFETY INFORMATION

Nutropin and your safety:
Please read this important safety information carefully. Then, if you have any questions, talk with your doctor.

Nutropin is NOT for:

• Children and teenagers whose bones have finished growing
• Patients who have certain types of eye disease caused by diabetes
• Patients who have active cancer or any brain tumors
• Patients who are critically ill after open heart surgery or abdominal (stomach) surgery, are severely hurt, or have severe breathing problems
• Children and teenagers who have Prader-Willi syndrome and are very overweight or have trouble breathing
• Patients with a known sensitivity to benzyl alcohol, an ingredient in the liquid used to mix Nutropin Injection. Sterile water should be used when mixing Nutropin for newborns.

If any of these apply, talk to your doctor before you start taking Nutropin.

If you are about to start taking Nutropin, or are already taking it, be sure to tell the doctor who prescribed it:

• About ALL of the medications you are taking, including supplements
• If you have or develop a brain tumor
• If you are given any new medication, especially glucocorticoid steroids like hydrocortisone or prednisone
• If you are pregnant or if you become pregnant
• About ANY other condition or illness you have or develop

What are the possible side effects of Nutropin?
You may experience discomfort, soreness, or redness where Nutropin is injected.

Contact your doctor immediately if you experience:

• Ongoing injection site discomfort
• Curvature of the spine (scoliosis)
• Joint pain
• Puffy hands and/or feet (caused by fluid retention)
• Changes in vision, a bad headache, or nausea with or without vomiting
• Hip or knee pain
• A need to limp when you walk
• Pain in wrist (carpal tunnel)
• Allergic reaction

Be sure to inject Nutropin at a different recommended place on your body each time. Your doctor or nurse should supervise the first injection and provide training and instruction.

Your doctor is your primary source of information about your treatment.

Please see the full Prescribing Information for Nutropin and Nutropin AQ, available from your pharmacy and at www.nutropin.com, for more about Nutropin and safety.

Questions? Call the Nurse Hotline at 1-866-NUTROPIN (1-866-688-7674).

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