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Turner Syndrome

Turner syndrome is a rare disorder that affects only girls. This is because the syndrome is caused by a problem with one of the two X chromosomes – the chromosomes responsible for a baby's gender. Turner syndrome may affect girls in different ways but shorter than normal height is among the most common signs. In fact, more than 95% of adult women with Turner syndrome are shorter than average.

Along with short stature, some other common physical conditions of Turner syndrome are:

  • Heart defects
  • Ovarian failure resulting in failure to progress through puberty at a normal age
  • Short neck with webbed appearance
  • Low hairline at the back of the neck
  • Differently shaped, low-set ears
  • High arched palate
  • Small jaw
  • Broad chest
  • Larger number of moles on the skin
  • Drooping eyelids
  • Triangular face
  • Puffy hands and feet (lymphedema)

Diagnosing Turner Syndrome

About one-third of patients with Turner syndrome are diagnosed as newborns due to puffy hands and feet (lymphedema) or thicker than normal neck skin. Another third are diagnosed in mid-childhood by their short stature and other patients are diagnosed later when they fail to enter puberty.

Girls with Turner syndrome may start to slow down in their growth as early as 18 months of age, and continue to grow slowly through childhood. As teens, girls with Turner syndrome typically don't have the growth spurt that other girls their age do. In fact, it's the absence of this growth spurt that may prompt a doctor to look for the presence of a disease that is preventing normal growth.

Treatment With Norditropin®

Short stature in girls with Turner syndrome is not due to a lack of growth hormone (GH), but for unknown reasons, the girl does not respond to the GH she makes herself. Fortunately, it has been shown that injecting GH in the form of a drug like Norditropin® may significantly increase height during these crucial growing years so that girls with Turner syndrome may reach close to their projected "normal" height.

Endocrinologists (hormone specialists) have different opinions on when to start GH treatment in patients with Turner syndrome. In the past, therapy commonly began between the ages of 6 and 12, depending when the condition was diagnosed.

Most doctors agree that it is important that treatment be continued until teenage growth is over—that is, when an X-ray can show that the epiphyses (the ends of the long bones in the hands) have fused.

We understand that the idea of daily injections may make some parents (and children) nervous about beginning treatment. However, our FlexPro® delivery pens were designed with ease and simplicity in mind.

  • All Norditropin® FlexPro® pens are pre-mixed and pre-loaded.
  • Unlike a lot of the other growth hormone devices, most FlexPro® pens do not need to be kept in a refrigerator after their first use, so they can go almost anywhere.*
  • NovoFine® needles are some of the smallest needles available.** The NovoFine® Autocover® 30G has a protective outer shield that hides the needle before, during and after the injection. This shield also locks into place after the injection to help reduce needlestick injuries. And it uses the 8-mm NovoFine® 30G needle, which 90% of patients surveyed found practically pain-free.

Because of its history and established safety profile, Norditropin® is a brand that pediatric endocrinologists rely on to help children grow taller during these critical growing years.

If you are considering treatment with Norditropin® for your child, discuss your questions with your pediatric endocrinologist. He or she will be able to provide you with a plan that's right for your child.

*All Norditropin® products must be refrigerated prior to first use. Do not freeze. After initial use, FlexPro® 5 mg/1.5 mL and 10 mg/1.5 mL delivery pens can either be stored outside of the refrigerator (at up to 77°F) for use within 3 weeks, or in the refrigerator (between 36°F and 46°F) for use within 4 weeks. The FlexPro® 15 mg/1.5 mL and NordiFlex® 30 mg/3 mL delivery pens must always be refrigerated (between 36°F and 46°F)—both prior to and after the initial injection—for use within 4 weeks.

**Needles are sold separately and may require a prescription in some states.

Support for Patients on Norditropin®

In addition to growth hormone therapy, Novo Nordisk also offers NordiCare®, a free support service for Norditropin® patients. NordiCare® is there throughout treatment to help with issues that could prevent a patient from receiving treatment such as:

  • Insurance problems or paying for Norditropin®
  • Getting started on therapy
  • Staying on treatment through unforeseen events, such as moving or changing insurance providers

With NordiCare®, each patient receives their own personal case manager, dedicated to handling their needs. You can call your case manager at any time during your treatment for answers and assistance. To learn more about NordiCare®, click here.

Learn More

The information here focuses on the short stature related to Turner syndrome, which is the only part of Turner syndrome that Norditropin® treats. To learn more about the other ways Turner syndrome may affect girls and women, please visit the following web sites:

The Turner Syndrome Society of the US http://www.turnersyndrome.org/

More detailed disease state information from the National Institutes of Health http://turners.nichd.nih.gov/

The Magic Foundation is a patient group with information on Turner syndrome and other growth hormone-related issues http://www.magicfoundation.org/www/docs/ 981.1070/turner_perspectives_jamie_harvey _erica_eugster.html

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Important Safety Information Jump Link

Indications and Usage

Norditropin® (somatropin [rDNA origin] injection) is used to treat: children who have growth failure because of low or no growth hormone; children who are short (in stature) and who have Noonan syndrome or Turner syndrome; children who are short (in stature) because they were born small (small for gestational age-SGA) and have not caught-up in growth by age 2 to 4 years; and adults who do not make enough growth hormone.

Important Safety Information

Do not use Norditropin® if: you have a critical illness caused by certain types of heart or stomach surgery, trauma or breathing (respiratory) problems; you are a child with Prader-Willi syndrome who is severely obese or has breathing problems including sleep apnea; you have cancer or other tumors; your healthcare provider tells you that you have certain types of eye problems caused by diabetes; you are a child with closed bone growth plates (epiphyses) or you are allergic to any of the ingredients in the medicine.

Before you take Norditropin®, tell your healthcare provider if you: have diabetes; had cancer or any tumor; have any other medical condition; are pregnant or plan to become pregnant; are breast-feeding or plan to breast-feed.

Norditropin® can cause serious side effects, including: high risk of death in people who have critical illnesses because of heart or stomach surgery, trauma or serious breathing (respiratory) problems; high risk of death in children with Prader-Willi syndrome who are severely obese or have breathing problems including sleep apnea; return of tumor or cancerous growths; high blood sugar (hyperglycemia); increase in pressure in the skull (intracranial hypertension); swollen hands and feet due to fluid retention; decrease in thyroid hormone levels; hip and knee pain or a limp in children (slipped capital femoral epiphysis); worsening of pre-existing curvature of the spine (scoliosis); middle ear infection, hearing problems or ear problems in patients with Turner syndrome.

Patients with Noonan syndrome and Turner syndrome should be closely monitored by their doctors as they are more likely to have congenital heart disease.

The most common side effects of Norditropin® include: headaches, muscle pain, joint stiffness, high blood sugar (hyperglycemia), sugar in your urine (glucosuria), swollen hands and feet due to fluid retention, and redness and itching in the area you inject. If you have headaches, eye problems, nausea or vomiting (these may be symptoms of raised pressure in the brain), contact your healthcare provider right away.

Norditropin® may affect how other medicines work, and other medicines may affect how Norditropin® works so be sure to tell your healthcare provider about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.

Especially tell your healthcare provider if you take: glucocorticoid medication, thyroid hormone, insulin or other medicine for diabetes, medicines that are metabolized by the liver (e.g., corticosteroids, sex steroids, anticonvulsants, cyclosporine), or oral estrogen replacement medicine.

For more information, please click here for complete Norditropin® Prescribing Information.

Norditropin® is a prescription medication.

Novo Nordisk provides patient assistance for those who qualify. Please call 1-866-310-7549 to learn more about Novo Nordisk assistance programs.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit www.fda.gov/medwatch, or call 1-800-FDA-1088

Talk to your healthcare provider and find out if Norditropin® is right for you or your child.

Norditropin®, FlexPro® and Norditropin NordiFlex® are registered trademarks of Novo Nordisk Health Care AG. NovoFine® and Novo Nordisk® are registered trademarks and Growth Track Wizard™ is a trademark of Novo Nordisk A/S.
Novo Nordisk Inc., 100 College Road West, Princeton, New Jersey 08540 U.S.A.
© 2012 Novo Nordisk    0212-00007508-1    August 2012