T HE GENE encoding GH-N (GHl) and those genes encoding chorionic somatomammotropin (CSH1,2) hormones reside in a 50,000 base-pair (50 kb) gene cluster on human chromosome 17 (Fig. 1) (1). The GH2 gene also resides in this cluster and encodes a protein (GH-V) that is expressed in the placenta rather than in the pituitary and differs from the primary sequence of GH-N by 13 amino acids. The CSH1,2 genes encode proteins of identical sequences, whereas the CSH pseudogene (CSHPl) encodes a protein differing by 13 amino acids and contains a mutation that should alter its pattern of messenger RNA (mRNA) splicing and thus the primary sequence of the resulting protein (1, 2). The extensive homology (92-98%) between the immediate flanking, intervening, and coding sequences of these 5 genes suggests that this multigene family arose through a series of gene duplication events (1, 3, 4). These duplications are thought to have arisen from successive unequal recombinations between Alu family repeats. This method of gene amplification is analogous to the Alu-Alu recombinations that cause deletions of the human @globin and low density lipoprotein receptor genes (5, 6). Expression of the GHl gene is controlled by cis and truns factors. The former include the CAT and TATA promoter components located 85 and 30 bp, respectively, upstream from the GHl gene’s origin of transcription. In addition, there are cis sequences that bind the Pit-I transacting factor. Thus, Pit-l factor binds to and activates the promoters of the GHl and PRL genes and also affects differentiation of thyrotropes (7). The frequency of GH deficiency is estimated to range from l/4,000-l/10,000 in various studies (8-11). Most cases are sporadic and are assumed to arise from cerebral insults or defects that include cerebral edema, chromosome anomalies, histiocytosis, infections, radiation, septo-optic dysplasia, trauma, or tumors affecting the hypothalamus or pituitary (1). Magnetic resonance exams detect hypothalamic or pituitary anomalies in about 12% of patients who have isolated GH deficiency (IGHD) (12).
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