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Turner syndrome

Turner syndrome (TS), also known as 45,X, or 45,X0, is a genetic disorder in which a person's cells have only one X chromosome or are partially missing an X chromosome (sex chromosome monosomy). Most people have two sex chromosomes (XX or XY). The chromosomal abnormality is often present in just some cells, in which case it is known as Turner syndrome with mosaicism. 45,X0 with mosaicism can occur in males or females, but Turner syndrome without mosaicism only occurs in females. Signs and symptoms vary among those affected. Often, a short and webbed neck, low-set ears, low hairline at the back of the neck, short stature, and swollen hands and feet are seen at birth. Typically, those affected do not develop menstrual periods or breasts without hormone treatment and are unable to have children without reproductive technology. Heart defects, diabetes, and hypothyroidism occur in the disorder more frequently than average. Most people with Turner syndrome have normal intelligence; however, many have problems with spatial visualization that may be needed in order to learn mathematics. Vision and hearing problems also occur more often than average.

Turner syndrome is not usually inherited; rather, it occurs during formation of the reproductive cells in a parent or in early cell division during development. No environmental risks are known, and the mother's age does not play a role. While most people have 46 chromosomes, people with Turner syndrome usually have 45 in some or all cells. In cases of mosaicism, the symptoms are usually fewer, and possibly none occur at all. Diagnosis is based on physical signs and genetic testing.

No cure for Turner syndrome is known. Treatment may help with symptoms. Human growth hormone injections during childhood may increase adult height. Estrogen replacement therapy can promote development of the breasts and hips. Medical care is often required to manage other health problems with which Turner syndrome is associated.

Turner syndrome occurs in between one in 2,000 and one in 5,000 females at birth. All regions of the world and cultures are affected about equally. Generally people with Turner syndrome have a shorter life expectancy, mostly due to heart problems and diabetes. American endocrinologist Henry Turner first described the condition in 1938. In 1964, it was determined to be due to a chromosomal abnormality.

Presentation
Turner syndrome has a number of physical and psychological impacts, including short stature, heart defects, neck webbing, delayed or absent puberty, and infertility. The phenotype of Turner syndrome is affected by mosaicism, where cell lines with a single sex chromosome are combined with those with multiple. Individuals with mosaicism of 45,X0/46,XY may be phenotypically male, female, or ambiguous, while those with 45,X0/46,XX will be phenotypically female. Patients with 45,X0/46,XY do not receive the diagnosis of Turner syndrome if phenotypically male. Around 40%–50% of cases of Turner syndrome are true "monosomy X" with a 45,X0 karyotype, while the remainder are mosaic for another cell line, most commonly 46,XX, or have other structural abnormalities of the X chromosome. The classic features of Turner syndrome, while distinctive, may be rarer than previously thought; incidental diagnosis, such as in biobank samples or prenatal testing for older mothers, finds many girls and women with few traditional signs of Turner syndrome.

Height
Turner syndrome is associated with short stature. The mean adult height of women with Turner syndrome without growth hormone therapy is around 20cm shorter than the mean of women in the general population. Mosaicism affects height in Turner syndrome; a large population sample drawn from the UK Biobank found women with 45,X0 karyotypes to have an average height of 145cm, while those with 45,X0/46,XX karyotypes averaged 159cm. The strength of the association between Turner syndrome and short stature is such that idiopathic short stature alone is a major diagnostic indication.

Growth delay in Turner syndrome does not begin at birth; most neonates with the condition have a birth weight in the lower end of the normal range. Height begins to lag in toddlerhood, with a delayed growth velocity becoming apparent as early as 18 months. When girls with Turner syndrome begin school, their height is usually still not remarkably unusual; marked short stature becomes obvious in mid-childhood. In undiagnosed preadolescents and adolescents, growth delay may be mistaken for a side effect of delayed puberty and improperly treated. Short stature in Turner syndrome and its counterpoint, tall stature in sex chromosome polysomy conditions such as Klinefelter syndrome, XYY syndrome, and trisomy X, is caused by the short-stature homeobox gene on the X and Y chromosomes. The absence of a copy of the SHOX gene in Turner's inhibits skeletal growth, resulting both in overall short stature and in a distinctive pattern of skeletal malformations including micrognathia (small chin), cubitus valgus (abnormal forearm angles), and short fingers.

When Turner syndrome is diagnosed in early life, growth hormone therapy can decrease the degree of short stature. The use of growth hormone therapy in Turner's originated from a series of studies in the 1980s finding it to substantially increase the height of treated girls, compared to prior adult height predictions and Turner's growth charts; treatment with human growth hormone appears to increase expected adult height by approximately 7cm from an otherwise expected norm of 142cm–147cm. In some cases oxandrolone, a steroid with a relatively mild masculinizing effect, may be used alongside growth hormone. The addition of oxandrolone to a Turner's treatment regimen adds around 2cm to the final height. Oxandrolone is used particularly often in girls diagnosed later in their growth period, due to the reduced impact of growth hormone alone in this population. However, oxandrolone use runs the risk of delayed breast development, voice deepening, increased body hair, or clitoromegaly. The effects of growth hormone therapy are at their strongest during the first year of treatment and taper off over time.

Physical features
In addition to short stature, Turner syndrome is associated with a number of characteristic physical features. These include a webbed neck, a low hairline, a small chin and jaw, a high-arched palate, and a broad chest with wide-spaced nipples. Lymphedema (swelling) of the hands and feet is common at birth and sometimes persistent throughout the lifespan. Some Turner's stigmata, such as cubitus valgus and shortened fingers, are related to SHOX gene dosage effects.

A number of the external manifestations of Turner syndrome are focused on the limbs, hands, and feet. Lymphedema at birth is one of the classic features of the syndrome; though it often resolves during toddlerhood, recurrence in later life is frequent, often without apparent cause. Cases where the retained X chromosome was inherited from the mother more often experience lymphedema than those where it was from the father. As a consequence of lymphedema's effects on nail anatomy, females with Turner syndrome frequently have small hypoplastic nails. Shortened metacarpal bones, particularly the fourth metacarpal, are a frequent finding. The body shape of individuals with Turner syndrome is frequently quite broad and stocky, as the growth deficiency is more pronounced in the length of bones than in their width. Scoliosis is common in Turner syndrome, and is seen in 40% of girls without growth hormone treatment.

Facial features associated with Turner syndrome include prominent ears, a low hairline, a webbed neck, a small chin with dental malocclusion, and downslanting palpebral fissures (the opening between the eyelids). These are thought to be related to lymphedema during the fetal period, specifically to the presence and resorption of excess fluids in the head and neck region. Neck webbing is a particularly distinctive trait of Turner syndrome, leading to many neonatal diagnoses. The underlying etiology of neck webbing is related to prenatal blood flow issues, and even in populations without Turner's has broad health consequences; the rate of congenital heart disease in webbed neck is 150-fold higher than in the general population, while the feature is also associated with reduced height and minor developmental impairments. Some women with Turner syndrome have premature facial wrinkling. Acne is less common in teenage girls and women with Turner syndrome, though the reasons why are unclear.

Other physical features connected to the condition include long eyelashes, sometimes including an additional set of eyelashes, and unusual dermatoglyphics (fingerprints). Some women with Turner's report being unable to create fingerprint passwords due to hypoplastic dermatoglyphics. Unusual dermatoglyphics are common to chromosome anomalies and in the case of Turner's may be a consequence of fetal lymphedema. Keloid scars, or raised hypertrophic scars growing beyond the boundaries of the original wound, are potentially associated with Turner syndrome; however, the association is underresearched. Though traditional medical counselling on the topic urges conservatism about elective procedures such as ear piercing due to the risk of severe scarring, the actual consequences are unclear. Keloids in Turner syndrome are particularly frequent following surgical procedures to reduce neck webbing. Turner syndrome has been associated with unusual patterns of hair growth, such as patches of short and long hair. Armpit and pubic hair is often sparse, while arm and leg hair is often thick. Though armpit hair is reduced in amount and thickness, the pattern in which it is implanted in the skin is as in men, rather than as in women.

Cardiac
Approximately half of individuals with Turner syndrome have congenital heart defects. CHDs associated with Turner syndrome include bicuspid aortic valves (30%), coarctation of the aorta (15%), and abnormalities of the arteries in the head and neck. A rare but potentially fatal complication of heart defects in Turner syndrome is aortic dissection, where the inner layer of the aorta tears open. Aortic dissection is six times as common in females with Turner syndrome as the general population and accounts for 8% of all deaths in the syndrome. The risk is substantially increased for individuals with bicuspid aortic valves, who make up 95% of patients with aortic dissection compared to 30% of all Turner's patients, and coarctation of the aorta, who make up 90% and 15% respectively.

Coronary artery disease onsets earlier in life in women with Turner syndrome compared to controls, and mortality from cardiac events is increased. This is thought to be in part a function of the relationship between Turner syndrome and obesity; women with Turner syndrome have a higher percentage of body fat for their weight than control women, and their short stature makes weight control more difficult. Though coronary artery disease is frequently thought a disease of older adults, young women with Turner syndrome are more likely to develop the disease than their 46,XX peers. Treatment recommendations for women with Turner syndrome and coronary artery disease are as in the general population, but as Turner's increases the risk of type 2 diabetes, women with insulin resistance must weigh up the benefits of prophylactic or early statin treatment with the risk of diabetes.

Internal medicine
Turner syndrome is associated with a broad variety of health considerations, such as liver and kidney issues, obesity, diabetes, and hypertension. Liver dysfunction is common in women with Turner syndrome, with 50%–80% having elevated liver enzymes. Non-alcoholic fatty liver disease is increased in prevalence in Turner syndrome, likely related in part to both conditions' associations with obesity. Hepatic vascular diseases are also seen in the syndrome as an aspect of Turner syndrome's broader vascular and cardiac impacts. Primary biliary cholangitis is more common in 45,X0 than 46,XX women. An unclear association exists between estrogen replacement therapy and liver dysfunction in Turner syndrome; some studies imply estrogen therapy worsens such conditions, while others imply improvement.

Kidney issues, such as horseshoe kidney, are sometimes observed in Turner syndrome. Horseshoe kidney, where the kidneys are fused together in a U-shape, occurs in around 10% of Turner's cases compared to less than 0.5% of the general population. A missing kidney is observed in as many as 5% of individuals with Turner syndrome, compared to around 0.1% of the population. A duplicated ureter, where two ureters drain a single kidney, occurs in as much as 20%–30% of the Turner syndrome population. Kidney malformations in Turner syndrome may be more common in mosaicism than in the full 45,X0 karyotype. Serious complications of the kidney anomalies associated with Turner syndrome are rare, although there is some risk of issues such as obstructive uropathy, where the flow of urine from the kidneys is blocked.

Women with Turner syndrome are more likely than average to have high blood pressure; as many as 60% of women with the condition are hypertensive. Isolated diastolic hypertension often precedes systolic hypertension in the condition and may develop at a young age. Treatments for hypertension in Turner syndrome are as in the general population.

Approximately 25%–80% of women with Turner syndrome have some level of insulin resistance, and a minority develop type 2 diabetes. The risk of diabetes in Turner syndrome varies by karyotype and appears to be raised by specific deletions of the short arm of the X chromosome (Xp). One study found that while a relatively low 9% of women with Xq (long arm) deletions had type 2 diabetes, 18% of those with full 45,X0 karyotypes did, as well as 23% with Xp deletions. 43% of women with isochromosome Xq, who both lacked the short arm and had an additional copy of the long arm, developed type 2 diabetes. Though part of the diabetes risk in Turner syndrome is a function of weight control, some is independent; age- and weight-matched women with non-Turner's ovarian failure have a lower diabetes risk than in Turner syndrome. Growth hormone treatment plays an unclear role in diabetes risk, as does estrogen supplementation.

The association between Turner syndrome and other diseases, such as cancer, is unclear. Overall, women with Turner syndrome do not appear more likely to develop cancer than women with 46,XX karyotypes, but the specific pattern of what cancers are highest risk seems to differ. The risk of breast cancer appears lower in Turner's than in control women, perhaps due to decreased levels of estrogen. Neuroblastoma, a cancer of infancy and early childhood, has been reported in girls with Turner syndrome. Tumours of the nervous system, both the central nervous system and the peripheral nervous system, are overrepresented amongst cancers in Turner syndrome. Furthermore, about 5.5% of Turner syndrome individuals have an extra, abnormal small supernumerary marker chromosome (sSMC) which consists of part of a Y chromosome. This partial Y chromosome-bearing sSMC may include the SRY gene located on the p arm of the Y chromosome at band 11.2 (notated as Yp11.2). This gene encodes the testis-determining factor protein (also known as sex-determining region Y protein). Turner syndrome individuals with this SRY gene-containing sSMC have a very real increased risk of developing gonadal tissue neoplasms such as gonadoblastomas and in situ seminomas (also termed dysgerminomas to indicate that this tumor has the pathology of the testicular tumor, seminoma, but develops in ovaries ). In one study, 34 Turner syndrome girls without overt evidence of these tumors were found at preventative surgery to have a gonadoblastoma (7 cases), dysgerminoma (1 case), or non-specific in situ gonadal neoplasm (1 case). Turner syndrome girls with this sSMC otherwise have typical features of the Turner syndrome except for a minority who also have hirsutism and/or clitoral enlargement. Surgical removal of the gonads has been recommended to remove the threat of developing these sSMC-associated neoplasms. Turner syndrome individuals with an sSMC that lacks the SRY gene are not at an increased risk of developing these cancers.

Sensory
Hearing loss is common in Turner syndrome. Though at birth hearing is generally normal, chronic middle ear problems are frequent throughout childhood, which can cause permanent conductive hearing loss. In adulthood, sensorineural hearing loss occurs more often than in 46,XX women and at younger ages; though differing thresholds of hearing loss make it difficult to compare between studies, younger adult women with Turner syndrome are routinely found to have disproportionate rates of hearing issues, with sometimes up to half of women in their 20s and 30s having poor hearing. This hearing loss is progressive; at the age of 40, women with Turner syndrome have equivalent hearing loss to 46,XX women aged 60, on average. Cohort studies imply hearing loss may be more common in women who also have metabolic syndrome. The high prevalence of sensorineural hearing loss in Turner syndrome appears to be related to SHOX deficiency.

Ocular and visual disorders are also increased in prevalence in Turner syndrome. More than half of individuals with Turner syndrome have some form of eye disorder. This may be a consequence of shared genes on the X chromosome in both eye and ovary development. Nearly half of cases have hyperopia or myopia, usually mild. Strabismus, or misalignment of the eye, occurs in around one-fifth to one-third of girls with Turner syndrome. As with strabismus outside the Turner's context, it may be treated with glasses, patching, or surgical correction. Esotropia, where the eye turns inwards, is more common than exotropia, where it turns outwards. Ptosis, or a drooping eyelid, is a common facial manifestation of Turner syndrome; it usually has no appreciable impact on vision, but severe cases may limit visual range and require surgical correction. The rate of red-green colourblindness in Turner syndrome is 8%, the same as in men. This is due to red-green colourblindness being an X-linked recessive condition; in people with a single X chromosome, whether normal males or Turner females, only a single mutated X is necessary for symptoms. Red-green colourblindness may be underdiagnosed in the Turner context, as the rarity of the condition in females reduces the likelihood of screening, and practitioners may not connect that the karyotype of Turner syndrome increases the risk from the female baseline.

Autoimmune
Women with Turner syndrome are two to three times as likely to develop autoimmune disorders as the general population. Specific autoimmune disorders linked to Turner syndrome include Hashimoto's disease, vitiligo, psoriasis and psoriatic arthritis, alopecia, and celiac disease. Inflammatory bowel disease is also common, while the prevalence of type 1 diabetes is unclear, though appears increased.

Thyroid disease is common in Turner syndrome. Hypothyroidism is prevalent; 30%–50% of women with Turner syndrome have Hashimoto's disease, where the thyroid gland is slowly destroyed by an autoimmune reaction. By age 50, half of women with Turner syndrome have subclinical or clinical hypothyroidism. Hyperthyroidism and Graves' disease are also increased in prevalence, though more modestly. The Turner's presentation of hyperthyroidism is as in the general population, while the presentation of hypothyroidism is often atypical, with a mild early presentation yet a more severe progression. Women with isochromosome Xq are more likely to develop autoimmune thyroid disease than women with other forms of Turner syndrome.

The risk of irritable bowel syndrome is increased around fivefold in Turner syndrome, and that of ulcerative colitis around fourfold. Celiac disease is also increased in prevalence, with around 4%–8% of Turner's patients having comorbid celiac disease compared to 0.5%–1% of the general population. Diagnosis of such conditions is difficult due to their nonspecific early symptoms. In the Turner's context, diagnosis may in particular be missed due to growth delay; such conditions cause growth delay and failure to thrive when they onset in childhood, but as girls with Turner syndrome already have such delay, symptoms may be overlooked and ascribed to the original condition.

Alopecia areata, or recurrent patchy hair loss, is three times as common in Turner syndrome as the general population. Alopecia in the Turner syndrome context is frequently treatment-resistant, also seen in other chromosome aneuploidies such as Down syndrome. Psoriasis is common in Turner syndrome, although the precise prevalence is unclear. Turner's psoriasis may be related to growth hormone treatment, as psoriasis as a side effect of such therapies has been reported in patients without the karyotype. Psoriasis may progress to psoriatic arthritis, and this progression may be more common in Turner syndrome. Vitiligo has been reported in conjunction with Turner syndrome, but the risk is unclear and may be a side effect of increased clinical attention to autoimmune disease in this population.

Puberty
Puberty is delayed or absent in Turner syndrome. A 2019 literature review found that 13% of women with a 45,X0 karyotype could expect to experience spontaneous thelarche (breast development), while 9% would undergo spontaneous menarche (beginning of menstruation). These numbers were higher in women with mosaic Turner's; 63% with 45,X0/46,XX karyotypes experienced spontaneous thelarche and 39% spontaneous menarche, while 88% with 45,X0/47,XXX (the presence of a trisomy X cell line) experienced spontaneous thelarche and 66% spontaneous menarche. Unexpectedly, women with Y-chromosome cells also had increased rates of thelarche and menarche compared to the 45,X0 baseline, at 41% and 19%. However, few women with trisomy X or Y-chromosome cell lines were covered in the review, impeding extrapolation from these results. 6% of women with Turner syndrome have regular menstrual cycles; the rest experience primary or secondary amenorrhea or other menstrual dysfunction.

In girls with Turner syndrome who do not experience spontaneous puberty, exogenous estrogen is used to induce and maintain feminization. Estrogen replacement is recommended to begin at around age 11–12, although some parents prefer to delay the induction of puberty in girls with lower social and emotional preparedness. The dose of estrogen in induced puberty begins at 10% of adult estrogen levels and is steadily increased at six-month intervals, with a full adult dose attained two to three years after the beginning of treatment. Estrogen replacement may interfere with growth hormone therapy, due to the closing effects of estrogen on growth plates; individuals must weigh up their preferences for taller height versus greater feminization.

Fertility
Women with Turner syndrome are at extremely high risk for primary ovarian insufficiency (POI) and infertility. Although about 70–80% have no spontaneous pubertal development and 90% experience primary amenorrhea, the remainder may possess a small residual of ovarian follicles at birth or early childhood.

Early in gestation, fetuses with Turner syndrome have a normal number of gametes in their developing ovaries, but this starts decreasing rapidly as early as 18 weeks of pregnancy; by birth, girls with the condition have markedly reduced follicular counts. Women with Turner syndrome who wish to raise families but are incapable of conception with their own oocytes have the options of adoption or of pregnancy with donor eggs; the latter has a comparable success rate to donor pregnancy in women with 46,XX karyotypes.

Pregnancy in Turner syndrome is inherently high-risk; the maternal death rate is 2%.

Usually, estrogen replacement therapy is used to spur the growth of secondary sexual characteristics at the time when puberty should onset. While very few women with Turner syndrome menstruate spontaneously, estrogen therapy requires a regular shedding of the uterine lining ("withdrawal bleeding") to prevent its overgrowth. Withdrawal bleeding can be induced monthly, like menstruation, or less often, usually every three months, if the patient desires. Estrogen therapy does not make a woman with nonfunctional ovaries fertile, but it plays an important role in assisted reproduction; the health of the uterus must be maintained with estrogen if an eligible woman with Turner Syndrome wishes to use IVF (using donated oocytes).

Especially in mosaic cases of Turner syndrome that contains Y-chromosome (e.g., 45,X/46,XY) due to the risk of development of ovarian malignancy (most common is gonadoblastoma) gonadectomy is recommended. Turner syndrome is characterized by primary amenorrhoea, premature ovarian failure (hypergonadotropic hypogonadism), streak gonads and infertility (however, technology (especially oocyte donation) provides the opportunity of pregnancy in these patients). Failure to develop secondary sex characteristics (sexual infantilism) is typical.

Neurodevelopmental
Individuals with Turner syndrome have normal intelligence. Verbal IQ is usually higher than performance IQ; one review of thirteen studies found an average verbal IQ of 101 compared to an average performance IQ of 89.

People with Turner syndrome demonstrate relative strengths in verbal skills, but may exhibit weaker nonverbal skills – particularly in arithmetic, select visuospatial skills, and processing speed. Turner syndrome does not typically cause intellectual disability or impair cognition. However, learning difficulties are common among women with Turner syndrome, particularly a specific difficulty in perceiving spatial relationships, such as nonverbal learning disorder. This may also manifest itself as a difficulty with motor control or with mathematics. While it is not correctable, in most cases it does not cause difficulty in daily living. Most Turner syndrome patients are employed as adults and lead productive lives.

Also, a rare variety of Turner syndrome, known as "Ring-X Turner syndrome", has about a 60% association with intellectual disability. This variety accounts for around 2–4% of all Turner syndrome cases.

Psychological
Social difficulties appear to be an area of vulnerability for TS girls. Counseling affected individuals and their families about the need to carefully develop social skills and relationships may prove useful in advancing social adaptation. Women with Turner syndrome may experience adverse psychosocial outcomes which can be improved through early intervention and the provision of appropriate psychological and psychiatric care. Genetic, hormonal, and medical problems associated with Turner syndrome are likely to affect psychosexual development of female adolescent patients, and thus influence their psychological functioning, behavior patterns, social interactions, and learning ability. Although Turner syndrome constitutes a chronic medical condition, with possible physical, social, and psychological complications in a woman's life, hormonal and estrogen replacement therapy, and assisted reproduction, are treatments that can be helpful for Turner syndrome patients and improve their quality of life. Research shows a possible association between age at diagnosis and increased substance use and depressive symptoms.

Prenatal
Despite the excellent postnatal prognosis, 99% of Turner syndrome conceptions are thought to end in miscarriage or stillbirth, and as many as 15% of all spontaneous abortions have the 45,X karyotype. Among cases that are detected by routine amniocentesis or chorionic villus sampling, one study found that the prevalence of Turner syndrome among tested pregnancies was 5.58 and 13.3 times higher, respectively, than among live neonates in a similar population.

Cause
Turner syndrome is caused by the complete or partial absence of one copy of the X chromosome in some or all the cells. The abnormal cells may have only one X (monosomy) (45,X) or they may be affected by one of several types of partial monosomy like a deletion of the short p arm of one X chromosome (46,X,del(Xp)) or the presence of an isochromosome with two q arms (46,X,i(Xq)) Turner syndrome has distinct features due to the lack of pseudoautosomal regions, which are typically spared from X-inactivation. In mosaic individuals, cells with X monosomy (45,X) may occur along with cells that are normal (46,XX), cells that have partial monosomies, or cells that have a Y chromosome (46,XY). The presence of mosaicism is estimated to be relatively common in affected individuals (67–90%).

The (46,X,i(Xq) isochromosome in the Turner syndrome is classified as a small supernumerary marker chromosome (sSMC). Two of the types of sSMCs in this syndrome contain parts of the genetic material from either an X or, much less frequently, Y chromosome and may or may not contain an XIST gene. Turner syndrome females with (46,X,i(Xq) sSMC consisting of a partial X chromosome that does not contain the XIST gene express at least some of this sSMC's genetic material and therefore contain excesses of this material. In consequence, they have a more serious form of the Turner syndrome that ranges form moderately severe to extremely severe. The extremely severe cases have anencephaly (absence of a major portion of the brain, skull, and scalp), agenesis of the corpus callosum (lack of the thick tract of nerve fibers that connect the left and right cerebral hemispheres), and complex heart deformities. Individuals with Turner syndrome that have partial X chromosome containing(46,X,i(Xq) sSMCs that have the XIST gene do not express this sSMC's genetic material and do not have the more severe manifestations of the syndrome.

Inheritance
In the majority of cases where monosomy occurs, the X chromosome comes from the mother. This may be due to a nondisjunction in the father. Meiotic errors that lead to the production of X with p arm deletions or abnormal Y chromosomes are also mostly found in the father. Isochromosome X or ring chromosome X on the other hand are formed equally often by both parents. Overall, the functional X chromosome usually comes from the mother.

In most cases, Turner syndrome is a sporadic event, and for the parents of an individual with Turner syndrome the risk of recurrence is not increased for subsequent pregnancies. Rare exceptions may include the presence of a balanced translocation of the X chromosome in a parent, or where the mother has 45,X mosaicism restricted to her germ cells.

Prenatal
Turner syndrome may be diagnosed by amniocentesis or chorionic villus sampling during pregnancy.

Usually, fetuses with Turner syndrome can be identified by abnormal ultrasound findings (i.e., heart defect, kidney abnormality, cystic hygroma, ascites). In a study of 19 European registries, 67.2% of prenatally diagnosed cases of Turner syndrome were detected by abnormalities on ultrasound. 69.1% of cases had one anomaly present, and 30.9% had two or more anomalies.

An increased risk of Turner syndrome may also be indicated by abnormal triple or quadruple maternal serum screen. The fetuses diagnosed through positive maternal serum screening are more often found to have a mosaic karyotype than those diagnosed based on ultrasonographic abnormalities, and conversely, those with mosaic karyotypes are less likely to have associated ultrasound abnormalities.

Postnatal
Turner syndrome can be diagnosed postnatally at any age. Often, it is diagnosed at birth due to heart problems, an unusually wide neck or swelling of the hands and feet. However, it is also common for it to go undiagnosed for several years, often until the girl reaches the age of puberty and fails to develop typically (the changes associated with puberty do not occur). In childhood, a short stature can be indicative of Turner syndrome.

A test called a karyotype, also known as a chromosome analysis, analyzes the chromosomal composition of the individual. This is the test of choice to diagnose Turner syndrome.

Treatment
As a chromosomal condition, there is no cure for Turner syndrome. However, much can be done to minimize the symptoms. While most of the physical findings are harmless, significant medical problems can be associated with the syndrome. Most of these significant conditions are treatable with surgery and other therapies including hormonal therapy.
 * Growth hormone, either alone or with a low dose of androgen, will increase growth and probably final adult height. Growth hormone is approved by the U.S. Food and Drug Administration for treatment of Turner syndrome and is covered by many insurance plans. There is evidence that this is effective, even in toddlers. A 2019 systematic review comparing effects of adding oxandrolone to growth hormone treatment to growth hormone alone has found moderate-quality evidence that the addition of oxandrolone leads to an increase in final adult height of girls with Turner syndrome. When the same review assessed the effects of adding Oxandrolone to growth hormone treatment on speech, cognition and psychological status, the results were inconclusive due to very-low quality evidence.
 * Estrogen replacement therapy such as the birth control pill, has been used since the condition was described in 1938 to promote development of secondary sexual characteristics. Estrogens are crucial for maintaining good bone integrity, cardiovascular health and tissue health. Women with Turner syndrome who do not have spontaneous puberty and who are not treated with estrogen are at high risk for osteoporosis and heart conditions.
 * Modern reproductive technologies have also been used to help women with Turner syndrome become pregnant if they desire. For example, a donor egg can be used to create an embryo, which is carried by the Turner syndrome woman.
 * Uterine maturity is positively associated with years of estrogen use, history of spontaneous menarche, and negatively associated with the lack of current hormone replacement therapy.

Epidemiology
Turner syndrome occurs in between one in 2000 and one in 5000 females at birth.

Approximately 99 percent of fetuses with Turner syndrome spontaneously terminate during the first trimester. Turner syndrome accounts for about 10 percent of the total number of spontaneous abortions in the United States.

History
The syndrome is named after Henry Turner, an American endocrinologist, who described it in 1938. In Europe, it is often called Ullrich–Turner syndrome and was sometimes called Bonnevie–Ullrich syndrome although the latter term is rarely used today. Both syndrome names acknowledge(d) that earlier cases had also been described by European doctors Kristine Bonnevie and Otto Ullrich. In Russian and Soviet literature, it is called Shereshevsky–Turner syndrome to acknowledge that the condition was first described as hereditary in 1925 by the Soviet endocrinologist Nikolai Shereshevsky, who believed that it was due to the underdevelopment of the gonads and the anterior pituitary gland and was combined with congenital malformations of internal development.

The first published report of a female with a 45,X karyotype was in 1959 by Charles Ford and colleagues in Harwell near Oxford, and Guy's Hospital in London. It was found in a 14-year-old girl with signs of Turner syndrome.

title: Turner syndrome


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LGM-30 Minuteman

The LGM-30 Minuteman is an American land-based intercontinental ballistic missile (ICBM) in service with the Air Force Global Strike Command. , the LGM-30G (Version 3) is the only land-based ICBM in service in the United States and represents the land leg of the U.S. nuclear triad, along with the Trident II submarine-launched ballistic missile (SLBM) and nuclear weapons carried by long-range strategic bombers.

Development of the Minuteman began in the mid-1950s when basic research indicated that a solid-fuel rocket motor could stand ready to launch for long periods of time, in contrast to liquid-fueled rockets that required fueling before launch and so might be destroyed in a surprise attack. The missile was named for the colonial minutemen of the American Revolutionary War, who could be ready to fight on short notice.

The Minuteman entered service in 1962 as a deterrence weapon that could hit Soviet cities with a second strike and countervalue counterattack if the U.S. was attacked. However, the development of the United States Navy (USN) UGM-27 Polaris, which addressed the same role, allowed the Air Force to modify the Minuteman, boosting its accuracy enough to attack hardened military targets, including Soviet missile silos. The Minuteman II entered service in 1965 with a host of upgrades to improve its accuracy and survivability in the face of an anti-ballistic missile (ABM) system the Soviets were known to be developing. In 1970, the Minuteman III became the first deployed ICBM with multiple independently targetable reentry vehicles (MIRV): three smaller warheads that improved the missile's ability to strike targets defended by ABMs. They were initially armed with the W62 warhead with a yield of 170 kilotons.

By the 1970s, 1,000 Minuteman missiles were deployed. This force has shrunk to 400 Minuteman III missiles, deployed in missile silos around Malmstrom AFB, Montana; Minot AFB, North Dakota; and Francis E. Warren AFB, Wyoming. The Minuteman III will be progressively replaced by the new LGM-35 Sentinel ICBM, to be built by Northrop Grumman, beginning in 2030.

Edward Hall and solid fuels
Minuteman owes its existence largely to Air Force Colonel Edward N. Hall, who in 1956 was given charge of the solid-fuel-propulsion division of General Bernard Schriever's Western Development Division, created to lead development of the SM-65 Atlas and HGM-25A Titan I ICBMs. Solid fuels were already commonly used in short-range rockets. Hall's superiors were interested in short- and medium-range missiles with solids, especially for use in Europe where the fast reaction time was an advantage for weapons that might be attacked by Soviet aircraft. But Hall was convinced that they could be used for a true ICBM with a 5500 nmi range.

To achieve the required energy, that year Hall began funding research at Boeing and Thiokol into the use of ammonium perchlorate composite propellant. Adapting a concept developed in the UK, they cast the fuel into large cylinders with a star-shaped hole running along the inner axis. This allowed the fuel to burn along the entire length of the cylinder, rather than just the end as in earlier designs. The increased burn rate meant increased thrust. This also meant the heat was spread across the entire motor, instead of the end, and because it burned from the inside out it did not reach the wall of the missile fuselage until the fuel was finished burning. In comparison, older designs burned primarily from one end to the other, meaning that at any instant one small section of the fuselage was being subjected to extreme loads and temperatures.

Guidance of an ICBM is based not only on the direction the missile is traveling but the precise instant that thrust is cut off. Too much thrust and the warhead will overshoot its target, too little and it will fall short. Solids are normally very hard to predict in terms of burn time and their instantaneous thrust during the burn, which made them questionable for the sort of accuracy required to hit a target at intercontinental range. While this initially appeared to be an insurmountable problem, it ended up being solved in an almost trivial fashion. A series of ports were added inside the rocket nozzle that were opened when the guidance systems called for engine cut-off. The reduction in pressure was so abrupt that the remaining fuel broke up and blew out the nozzle without contributing to the thrust.

The first to use these developments was the US Navy. It had been involved in a joint program with the US Army to develop the liquid-fueled PGM-19 Jupiter, but had always been skeptical of the system. The Navy felt that liquid fuels were too dangerous to use onboard ships, especially submarines. Rapid success in the solids development program, combined with Edward Teller's promise of much lighter nuclear warheads during Project Nobska, led the Navy to abandon Jupiter and begin development of their own solid-fuel missile. Aerojet's work with Hall was adapted for their UGM-27 Polaris starting in December 1956.

Missile farm concept
The US Air Force saw no pressing need for a solid fuel ICBM. Development of the SM-65 Atlas and SM-68 Titan ICBMs was progressing, and "storable" liquids were being developed that would allow missiles to be left in a ready-to-shoot form for extended periods. These could be placed in missile silos for added protection, and launch in minutes. This met their need for a weapon that would be safe from sneak attacks; hitting all of the silos within a limited time window before they could launch simply did not seem possible.

But Hall saw solid fuels not only as a way to improve launch times or survivability, but part of a radical plan to greatly reduce the cost of ICBMs so that thousands could be built. He envisioned a future where ICBMs were the primary weapon of the US, not in the supporting role of "last ditch backup" as the Air Force saw them at the time. This would require huge deployments, which would not be possible with existing weapons due to their high cost and operational manpower requirements. A solid fuel design would be simpler to build, and easier to maintain.

Hall's ultimate plan was to build a number of integrated missile "farms" that included factories, missile silos, transport and recycling. He was aware that new computerized assembly lines would allow continual production, and that similar equipment would allow a small team to oversee operations for dozens or hundreds of missiles, radically reducing the manpower requirements. Each farm would support between 1,000 and 1,500 missiles being produced in a continuous low rate cycle. Systems in a missile would detect failures, at which point it would be removed and recycled, while a newly built missile would take its place. The missile design was based purely on lowest possible cost, reducing its size and complexity because "the basis of the weapon's merit was its low cost per completed mission; all other factors – accuracy, vulnerability, and reliability – were secondary."

Hall's plan did not go unopposed, especially by the more established names in the ICBM field. Ramo-Wooldridge pressed for a system with higher accuracy, but Hall countered that the missile's role was to attack Soviet cities, and that "a force which provides numerical superiority over the enemy will provide a much stronger deterrent than a numerically inferior force of greater accuracy." Hall was known for his "friction with others" and in 1958 Schriever removed him from the Minuteman project, sending him to the UK to oversee deployment of the Thor IRBM. On his return to the US in 1959, Hall retired from the Air Force. He received his second Legion of Merit in 1960 for his work on solid fuels.

Although he was removed from the Minuteman project, Hall's work on cost reduction had already produced a new design of 71 in diameter, much smaller than the Atlas and Titan at 120 in, which meant smaller and cheaper silos. Hall's goal of dramatic cost reduction was a success, although many of the other concepts of his missile farm were abandoned.

Guidance system

Previous long-range missiles used liquid fuels that could be loaded only just prior to firing. The loading process took from 30 to 60 minutes in typical designs. Although lengthy, this was not considered to be a problem at the time, because it took about the same amount of time to spin up the inertial guidance system, set the initial position, and program in the target coordinates.

Minuteman was designed from the outset to be launched in minutes. While solid fuel eliminated the fueling delays, the delays in starting and aligning the guidance system remained. For the desired quick launch, the guidance system would have to be kept running and aligned at all times. This was a serious problem for the mechanical systems, especially the gyroscopes which used ball bearings.

Autonetics had an experimental design using air bearings that they claimed had been running continually from 1952 to 1957. Autonetics further advanced the state of the art by building the platform in the form of a ball which could rotate in two directions. Conventional solutions used a shaft with ball bearings at either end that allowed it to rotate around a single axis only. Autonetics' design meant that only two gyros would be needed for the inertial platform, instead of the typical three.

The last major advance was to use a general-purpose digital computer in place of the analog or custom designed digital computers. Previous missile designs normally used two single-purpose and very simple electromechanical computers; one ran the autopilot that kept the missile flying along a programmed course, and the second compared the information from the inertial platform to the target coordinates and sent any needed corrections to the autopilot. To reduce the total number of parts used in Minuteman, a single faster computer was used, running separate subroutines for these functions.

Since the guidance program would not be running while the missile sat in the silo, the same computer was also used to run a program that monitored the various sensors and test equipment. With older designs this had been handled by external systems, requiring miles of extra wiring and many connectors to locations where test instruments could be connected during servicing. Now these could all be accomplished by communicating with the computer through a single connection. In order to store multiple programs, the computer, the D-17B, was built in the form of a drum machine but used a hard disk in place of the drum.

Building a computer with the required performance, size and weight demanded the use of transistors, which were at that time very expensive and not very reliable. Earlier efforts to use computers for guidance, BINAC and the system on the SM-64 Navaho, had failed and were abandoned. The Air Force and Autonetics spent millions on a program to improve transistor and component reliability 100 times, leading to the "Minuteman high-rel parts" specifications. The techniques developed during this program were equally useful for improving all transistor construction, and greatly reduced the failure rate of transistor production lines in general. This improved yield, which had the effect of greatly lowering production costs, had enormous spin-off effects in the electronics industry.

Using a general-purpose computer also had long-lasting effects on the Minuteman program and the US's nuclear stance in general. With Minuteman, the targeting could be easily changed by loading new trajectory information into the computer's hard drive, a task that could be completed in a few hours. Earlier ICBMs' custom wired computers, on the other hand, could have attacked only a single target, whose precise trajectory information was hard-coded directly in the system's logic.

Missile gap
In 1957, a series of intelligence reports suggested the Soviet Union was far ahead in the missile race and would be able to overwhelm the US by the early 1960s. If the Soviets were building missiles in the numbers being predicted by the CIA and others within the defense establishment, by as early as 1961 they would have enough to attack all SAC and ICBM bases in the US in a single first strike. It was later demonstrated that this "missile gap" was just as fictional as the "bomber gap" of a few years earlier, but through the late 1950s, it was a serious concern.

The Air Force responded by beginning research into survivable strategic missiles, starting the WS-199 program. Initially, this focused on air-launched ballistic missiles, which would be carried aboard aircraft flying far from the Soviet Union, and thus impossible to attack by either ICBM, because they were moving, or long-range interceptor aircraft, because they were too far away. In the shorter term, looking to rapidly increase the number of missiles in its force, Minuteman was given crash development status starting in September 1958. Advanced surveying of the potential silo sites had already begun in late 1957.

Adding to their concerns was a Soviet anti-ballistic missile system which was known to be under development at Sary Shagan. WS-199 was expanded to develop a maneuvering reentry vehicle (MARV), which greatly complicated the problem of shooting down a warhead. Two designs were tested in 1957, Alpha Draco and the Boost Glide Reentry Vehicle. These used long and skinny arrow-like shapes that provided aerodynamic lift in the high atmosphere, and could be fitted to existing missiles like Minuteman.

The shape of these reentry vehicles required more room on the front of the missile than a traditional reentry vehicle design. To allow for this future expansion, the Minuteman silos were revised to be built 13 feet deeper. Although Minuteman would not deploy a boost-glide warhead, the extra space proved invaluable in the future, as it allowed the missile to be extended and carry more fuel and payload.

Polaris

During Minuteman's early development, the Air Force maintained the policy that the manned strategic bomber was the primary weapon of nuclear war. Blind bombing accuracy on the order of 1500 feet was expected, and the weapons were sized to ensure even the hardest targets would be destroyed as long as the weapon fell within this range. The USAF had enough bombers to attack every military and industrial target in the USSR and was confident that its bombers would survive in sufficient numbers that such a strike would utterly destroy the country.

Soviet ICBMs upset this equation to a degree. Their accuracy was known to be low, on the order of 4 nmi, but they carried large warheads that would be useful against Strategic Air Command's bombers, which parked in the open. Since there was no system to detect the ICBMs being launched, the possibility was raised that the Soviets could launch a sneak attack with a few dozen missiles that would take out a significant portion of SAC's bomber fleet.

In this environment, the Air Force saw their own ICBMs not as a primary weapon of war, but as a way to ensure that the Soviets would not risk a sneak attack. ICBMs, especially newer models that were housed in silos, could be expected to survive an attack by a single Soviet missile. In any conceivable scenario where both sides had similar numbers of ICBMs, the US forces would survive a sneak attack in sufficient numbers to ensure the destruction of all major Soviet cities in return. The Soviets would not risk an attack under these conditions.

Considering this countervalue attack concept, strategic planners calculated that an attack of "400 equivalent megatons" aimed at the largest Soviet cities would promptly kill 30% of their population and destroy 50% of their industry. Larger attacks raised these numbers only slightly, as all of the larger targets would already have been hit. This suggested that there was a "finite deterrent" level around 400 megatons that would be enough to prevent a Soviet attack no matter how many missiles they had of their own. All that had to be ensured was that the US missiles survived, which seemed likely given the low accuracy of the Soviet weapons. Reversing the problem, the addition of ICBMs to the US Air Force's arsenal did not eliminate the need, or desire, to attack Soviet military targets, and the Air Force maintained that bombers were the only suitable platform in that role.

Into this argument came the Navy's UGM-27 Polaris. Launched from submarines, Polaris was effectively invulnerable and had enough accuracy to attack Soviet cities. If the Soviets improved the accuracy of their missiles this would present a serious threat to the Air Force's bombers and missiles, but none at all to the Navy's submarines. Based on the same 400 equivalent megatons calculation, they set about building a fleet of 41 submarines carrying 16 missiles each, giving the Navy a finite deterrent that was unassailable.

This presented a serious problem for the Air Force. They were still pressing for the development of newer bombers, like the supersonic B-70, for attacks against military targets, but this role seemed increasingly unlikely in a nuclear war scenario. A February 1960 memo by RAND, entitled "The Puzzle of Polaris", was passed around among high-ranking Air Force officials. It suggested that Polaris negated any need for Air Force ICBMs if they were also being aimed at Soviet cities. If the role of the missile was to present an unassailable threat to the Soviet population, Polaris was a far better solution than Minuteman. The document had long-lasting effects on the future of the Minuteman program, which, by 1961, was firmly evolving towards a counterforce capability.

Kennedy
Minuteman's final tests coincided with John F. Kennedy entering the White House. His new Secretary of Defense, Robert McNamara, was tasked with continuing the expansion and modernisation of the US nuclear deterrent while limiting spending. McNamara began to apply cost/benefit analysis, and Minuteman's low production cost made its selection a foregone conclusion. Atlas and Titan were soon scrapped, and the storable liquid fueled Titan II deployment was severely curtailed. McNamara also cancelled the XB-70 bomber project.

Minuteman's low cost had spin-off effects on non-ICBM programs. The Army's Nike Zeus, an interceptor missile capable of shooting down Soviet warheads, provided another way to prevent a sneak attack. This had initially been proposed as a way to defend the SAC bomber fleet. The Army argued that upgraded Soviet missiles might be able to attack US missiles in their silos, and Zeus would be able to blunt such an attack. Zeus was expensive and the Air Force said it was more cost-effective to build another Minuteman missile. Given the large size and complexity of the Soviet liquid-fueled missiles, an ICBM building race was one the Soviets could not afford. Zeus was canceled in 1963.

Counterforce
Minuteman's selection as the primary Air Force ICBM was initially based on the same "second strike" logic as their earlier missiles: that the weapon was primarily one designed to survive any potential Soviet attack and ensure they would be hit in return. But Minuteman had a combination of features that led to its rapid evolution into the US's primary weapon of nuclear war.

Chief among these qualities was its digital computer, the D-17B. This could be updated in the field with new targets and better information about the flight paths with relative ease, gaining accuracy for little cost. One of the unavoidable effects on the warhead's trajectory was the mass of the Earth, which contains many mass concentrations that pull on the warhead as it passes over them. Through the 1960s, the Defense Mapping Agency (now part of National Geospatial-Intelligence Agency) mapped these with increasing accuracy, feeding that information back into the Minuteman fleet. The Minuteman was initially deployed with a circular error probable (CEP) of about 1.1 nmi, but this had improved to about 0.6 nmi by 1965. This was accomplished without any mechanical changes to the missile or its navigation system.

At those levels, the ICBM begins to approach the manned bomber in terms of accuracy; a small upgrade, roughly doubling the accuracy of the INS, would give it the same 1500 feet CEP as the manned bomber. Autonetics began such development even before the original Minuteman entered fleet service, and the Minuteman II had a CEP of 0.26 nmi. Additionally, the computers were upgraded with more memory, allowing them to store information for eight targets, which the missile crews could select among almost instantly, greatly increasing their flexibility. From that point, Minuteman became the US's primary deterrent weapon, until its performance was matched by the Navy's Trident missile of the 1980s.

Questions about the need for the manned bomber were quickly raised. The Air Force began to offer a number of reasons why the bomber offered value, in spite of costing more money to buy and being much more expensive to operate and maintain. Newer bombers with better survivability, like the B-70, cost many times more than the Minuteman, and, in spite of great efforts through the 1960s, became increasingly vulnerable to surface-to-air missiles. The B-1 of the early 1970s eventually emerged with a price tag around $200 million (equivalent to $ million in ) while the Minuteman IIIs built during the 1970s cost only $7 million ($ million in ).

The Air Force countered that having a variety of platforms complicated the defense; if the Soviets built an effective anti-ballistic missile system of some sort, the ICBM and SLBM fleet might be rendered useless, while the bombers would remain. This became the nuclear triad concept, which survives into the present. Although this argument was successful, the number of manned bombers has been repeatedly cut and the deterrent role increasingly passed to missiles.

Minuteman I (LGM-30A/B or SM-80/HSM-80A)

 * See also W56 Warhead

Deployment
The LGM-30A Minuteman I was first test-fired on 1 February 1961 at Cape Canaveral,   and entered into the Strategic Air Command's arsenal in 1962. After the first batch of Minuteman I's were fully developed and ready for stationing, the United States Air Force (USAF) had originally decided to put the missiles at Vandenberg AFB in California, but before the missiles were set to officially be moved there it was discovered that this first set of Minuteman missiles had defective boosters which limited their range from their initial 6300 mi to 4300 mi. This defect would cause the missiles to fall short of their targets if launched over the North Pole as planned. The decision was made to station the missiles at Malmstrom AFB in Montana instead. These changes would allow the missiles, even with their defective boosters, to reach their intended targets in the case of a launch.

The "improved" LGM-30B Minuteman I became operational at Ellsworth AFB, South Dakota, Minot AFB, North Dakota, F.E. Warren AFB, Wyoming, and Whiteman AFB, Missouri, in 1963 and 1964. All 800 Minuteman I missiles were delivered by June 1965. Each of the bases had 150 missiles emplaced; F.E. Warren had 200 of the Minuteman IB missiles. Malmstrom had 150 of the Minuteman I, and about five years later added 50 of the Minuteman II similar to those installed at Grand Forks AFB, ND.

Specifications
The Minuteman I's length varied based on which variation one was to look at. The Minuteman I/A had a length of 53 ft and the Minuteman I/B had a length of 55 ft. The Minuteman I weighed roughly 65000 lb, had an operational range of 5500 mi with an accuracy of about 1.5 mi.

Guidance
The Minuteman I Autonetics D-17 flight computer used a rotating air bearing magnetic disk holding 2,560 "cold-stored" words in 20 tracks (write heads disabled after program fill) of 24 bits each and one alterable track of 128 words. The time for a D-17 disk revolution was 10 ms. The D-17 also used a number of short loops for faster access to intermediate results storage. The D-17 computational minor cycle was three disk revolutions or 30 ms. During that time all recurring computations were performed. For ground operations, the inertial platform was aligned and gyro correction rates updated.

During a flight, filtered command outputs were sent by each minor cycle to the engine nozzles. Unlike modern computers, which use descendants of that technology for secondary storage on hard disk, the disk was the active computer memory. The disk storage was considered hardened to radiation from nearby nuclear explosions, making it an ideal storage medium. To improve computational speed, the D-17 borrowed an instruction look-ahead feature from the Autonetics-built Field Artillery Data Computer (M18 FADAC) that permitted simple instruction execution every word time.

Warhead
At its introduction into service in 1962, Minuteman I was fitted with the W59 warhead with a yield of 1 Mt. Production for the W56 warhead with a 1.2 Mt yield began in March 1963 and W59 production was ended in July 1963 with a production run of only 150 warheads before being retired in June 1969. The W56 would continue production until May 1969 with a production run of 1000 warheads. Mods 0 to 3 were retired by September 1966 and the Mod 4 version would remain in service until the 1990s.

It's not clear exactly why the W59 was replaced by the W56 after deployment but issues with "... one-point safety" and "performance under aged conditions" were cited in a 1987 congressional report regarding the warhead. Chuck Hansen alleged that all weapons sharing the "Tsetse" nuclear primary design including the W59 suffered from a critical one-point safety issue and suffered premature tritium aging issues that needed to be corrected after entry into service.

Minuteman II (LGM-30F)

 * See also W56 warhead

The LGM-30F Minuteman II was an improved version of the Minuteman I missile. Its first test launch took place on September 24, 1964. Development on the Minuteman II began in 1962 as the Minuteman I entered the Strategic Air Command's nuclear force. Minuteman II production and deployment began in 1965 and completed in 1967. It had an increased range, greater throw weight and guidance system with better azimuthal coverage, providing military planners with better accuracy and a wider range of targets. Some missiles also carried penetration aids, allowing the higher probability of kill against Moscow's anti-ballistic missile system. The payload consisted of a single Mk-11C reentry vehicle containing a W56 nuclear warhead with a yield of 1.2 megatons of TNT (5 PJ).

Specifications
The Minuteman II had a length of 57 ft, weighed roughly 73000 lb, had an operational range of 10200 km with an accuracy of about 1 mi.

The major new features provided by Minuteman II were:

 * An improved first-stage motor to increase reliability.
 * A novel, single, fixed nozzle with liquid injection thrust vector control on a larger second-stage motor to increase missile range. Additional motor improvements to increase reliability.
 * An improved guidance system (the D-37 flight computer), incorporating microchips and miniaturized discrete electronic parts. Minuteman II was the first program to make a major commitment to these new devices. Their use made possible multiple target selection, greater accuracy and reliability, a reduction in the overall size and weight of the guidance system, and an increase in the survivability of the guidance system in a nuclear environment. The guidance system contained 2,000 microchips made by Texas Instruments.
 * A penetration aids system to camouflage the warhead during its reentry into an enemy environment. In addition, the Mk-11C reentry vehicle incorporated stealth features to reduce its radar signature and make it more difficult to distinguish from decoys. The Mk-11C was no longer made of titanium for this and other reasons.
 * A larger warhead in the reentry vehicle to increase kill probability.

System modernization was concentrated on launch facilities and command and control facilities. This provided decreased reaction time and increased survivability when under nuclear attack. Final changes to the system were performed to increase compatibility with the expected LGM-118A Peacekeeper. These newer missiles were later deployed into modified Minuteman silos.

The Minuteman II program was the first mass-produced system to use a computer constructed from integrated circuits (the Autonetics D-37C). The Minuteman II integrated circuits were diode–transistor logic and diode logic made by Texas Instruments. The other major customer of early integrated circuits was the Apollo Guidance Computer, which had similar weight and ruggedness constraints. The Apollo integrated circuits were resistor–transistor logic made by Fairchild Semiconductor. The Minuteman II flight computer continued to use rotating magnetic disks for primary storage. The Minuteman II included diodes by Microsemi Corporation.

Minuteman III (LGM-30G)

 * See also W62 warhead

The LGM-30G Minuteman III program started in 1966 and included several improvements over the previous versions. Its first test launch took place on August 16, 1968. It was first deployed in 1970. Most modifications related to the final stage and reentry system (RS). The final (third) stage was improved with a new fluid-injected motor, giving finer control than the previous four-nozzle system. Performance improvements realized in Minuteman III include increased flexibility in reentry vehicle (RV) and penetration aids deployment, increased survivability after a nuclear attack, and increased payload capacity. The missile retains a gimballed inertial navigation system.

Minuteman III originally contained the following distinguishing features:

 * Armed with up to three W62 Mk-12 warheads, having a yield of only 170 kilotons TNT, instead of previous W56's yield of 1.2 megatons.
 * It was the first missile equipped with multiple independently targetable reentry vehicles (MIRV). A single missile was then able to target three separate locations. This was an improvement from the Minuteman I and Minuteman II models, which were able to carry only one large warhead.
 * An RS capable of deploying, in addition to the warheads, penetration aids such as chaff and decoys.
 * Minuteman III introduced in the post-boost-stage ("bus") an additional liquid-fuel propulsion system rocket engine (PSRE) that is used to slightly adjust the trajectory. This enables it to dispense decoys or – with MIRV – dispense individual RVs to separate targets. For the PSRE it uses the bipropellant Rocketdyne RS-14 engine.
 * The Hercules M57 third stage of Minuteman I and Minuteman II had thrust termination ports on the sides. These ports, when opened by detonation of shaped charges, reduced the chamber pressure so abruptly that the interior flame was blown out. This allowed a precisely timed termination of thrust for targeting accuracy. The larger Minuteman III third-stage motor also has thrust termination ports although the final velocity is determined by PSRE.
 * A fixed nozzle with a liquid injection thrust vector control system on the new third-stage motor (similar to the second-stage Minuteman II nozzle) additionally increased range.
 * A flight computer (Autonetics D37D) with larger disk memory and enhanced capability.
 * A Honeywell HDC-701 flight computer which employed non-destructive readout plated-wire memory instead of rotating magnetic disk for primary storage was developed as a backup for the D37D but was never adopted.
 * The Guidance Replacement Program, initiated in 1993, replaced the disk-based D37D flight computer with a new one that uses radiation-resistant semiconductor RAM.

The Minuteman III missiles use D-37D computers and complete the 1,000 missile deployment of this system. The initial cost of these computers range from about $139,000 (D-37C) to $250,000 (D-17B).

Minuteman III MIRV path.svg launch sequence:

1. The missile launches out of its silo by firing its 1st-stage boost motor (A).

2. About 60 seconds after launch, the 1st stage drops off and the 2nd-stage motor (B) ignites. The missile shroud (E) is ejected.

3. About 120 seconds after launch, the 3rd-stage motor (C) ignites and separates from the 2nd stage.

4. About 180 seconds after launch, 3rd-stage thrust terminates and the Post-Boost Vehicle (D) separates from the rocket.

5. The Post-Boost Vehicle maneuvers itself and prepares for re-entry vehicle (RV) deployment.

6. The RVs, as well as decoys and chaff, are deployed during back away.

7. The RVs and chaff re-enter the atmosphere at high speeds and are armed in flight.

8. The nuclear warheads initiate, either as air bursts or ground bursts.]]

The existing Minuteman III missiles have been further improved over the decades in service, with more than $7 billion spent in the 2010s to upgrade the 450 missiles.

Specifications
The Minuteman III has a length of 59.9 ft, weighs 79,432 lb, an operational range of 14000 km, and an accuracy of about 800 ft.

W78 warhead
In December 1979 the higher-yield W78 warhead (335–350 kilotons) began replacing a number of the W62s deployed on the Minuteman IIIs. These were delivered in the Mark 12A reentry vehicle. A small, unknown number of the previous Mark 12 RVs were retained operationally, however, to maintain a capability to attack more-distant targets in the south-central Asian republics of the USSR (the Mark 12 RV weighed slightly less than the Mark 12A).

Guidance Replacement Program
The Guidance Replacement Program replaces the NS20A Missile Guidance Set with the NS50 Missile Guidance Set. The newer system extends the service life of the Minuteman missile beyond the year 2030 by replacing aging parts and assemblies with current, high reliability technology while maintaining the current accuracy performance. The replacement program was completed 25 February 2008.

Propulsion Replacement Program
Beginning in 1998 and continuing through 2009, the Propulsion Replacement Program extends the life and maintains the performance by replacing the old solid propellant boosters (downstages).

Single Reentry Vehicle
The Single Reentry Vehicle modification enabled the United States ICBM force to abide by the now-voided START II treaty requirements by reconfiguring Minuteman III missiles from three reentry vehicles down to one. Though it was eventually ratified by both parties, START II never entered into force and was essentially superseded by follow-on agreements such as SORT and New START, which do not limit MIRV capability. Minuteman III remains fitted with a single warhead due to the warhead limitations in New START.

Safety Enhanced Reentry Vehicle
Beginning in 2005, Mk-21/W87 RVs from the deactivated Peacekeeper missile were replaced on the Minuteman III force under the Safety Enhanced Reentry Vehicle (SERV) program. The older W78 did not have many of the safety features of the newer W87, such as insensitive high explosives, as well as more advanced safety devices. In addition to implementing these safety features in at least a portion of the future Minuteman III force, the decision to transfer W87s onto the missile was based on two features that improved the targeting capabilities of the weapon: more fuzing options which allowed for greater targeting flexibility, and the most accurate reentry vehicle available, which provided a greater probability of damage to the designated targets.

Deployment
The Minuteman III missile entered service in 1970, with weapon systems upgrades included during the production run from 1970 to 1978 to increase accuracy and payload capacity. , the USAF plans to operate it until the mid-2030s.

The LGM-118A Peacekeeper (MX) ICBM, which was to have replaced the Minuteman, was retired in 2005 as part of START II.

A total of 450 LGM-30G missiles are emplaced at F.E. Warren Air Force Base, Wyoming (90th Missile Wing), Minot Air Force Base, North Dakota (91st Missile Wing), and Malmstrom Air Force Base, Montana (341st Missile Wing). All Minuteman I and Minuteman II missiles have been retired. The United States prefers to keep its MIRV deterrents on submarine-launched Trident Nuclear Missiles In 2014, the Air Force decided to put fifty Minuteman III silos into "warm" unarmed status, taking up half of the 100 slots in America's allowable nuclear reserve. These can be reloaded in the future if necessary.

Testing
Minuteman III missiles are regularly tested with launches from Vandenberg Space Force Base in order to validate the effectiveness, readiness, and accuracy of the weapon system, as well as to support the system's primary purpose, nuclear deterrence. The safety features installed on the Minuteman III for each test launch allow the flight controllers to terminate the flight at any time if the systems indicate that its course may take it unsafely over inhabited areas. Since these flights are for test purposes only, even terminated flights can send back valuable information to correct a potential problem with the system.

The 576th Flight Test Squadron is responsible for planning, preparing, conducting, and assessing all ICBM ground and flight tests.

Airborne Launch Control System (ALCS)
The Airborne Launch Control System (ALCS) is an integral part of the Minuteman ICBM command and control system and provides a survivable launch capability for the Minuteman ICBM force if ground-based launch control centers (LCCs) are destroyed.

When the Minuteman ICBM was first placed on alert, the Soviet Union did not have the number of weapons, accuracy, nor significant nuclear yield to completely destroy the Minuteman ICBM force during an attack. However, starting in the mid-1960s, the Soviets began to gain parity with the US and potentially had the capability to target and successfully attack the Minuteman force with an increased number of ICBMs that had greater yields and accuracy than were previously available.

Studying the problem, SAC realized that in order to prevent the US from launching all 1,000 Minuteman ICBMs, the Soviets did not have to target all 1,000 Minuteman missile silos. The Soviets needed to launch only a disarming decapitation strike against the 100 Minuteman LCCs – the command and control sites – in order to prevent the launch of all Minuteman ICBMs. Even though the Minuteman ICBMs would have been left unscathed in their missile silos following an LCC decapitation strike, the Minuteman missiles could not be launched without a command and control capability.

In other words, the Soviets needed only 100 warheads to eliminate command and control of the Minuteman ICBMs. Even if the Soviets chose to expend two to three warheads per LCC for assured damage expectancy, the Soviets would have had to expend only up to 300 warheads to disable the Minuteman ICBM force – far less than the total number of Minuteman silos. The Soviets could have then used the remaining warheads to strike other targets they chose.

Faced with only a few Minuteman LCC targets, the Soviets could have concluded that the odds of being successful in a Minuteman LCC decapitation strike were higher with less risk than it would have been having to face the almost insurmountable task of successfully attacking and destroying 1000 Minuteman silos and 100 Minuteman LCCs to ensure Minuteman was disabled. This theory motivated SAC to design a survivable means to launch Minuteman, even if all the ground-based command and control sites were destroyed.

After thorough testing and modification of EC-135 command post aircraft, the ALCS demonstrated its capability on 17 April 1967 by launching an ERCS configured Minuteman II out of Vandenberg AFB, CA. Afterward, ALCS achieved Initial Operational Capability on 31 May 1967. From that point on, airborne missileers stood alert with ALCS-capable EC-135 aircraft for several decades. All Minuteman ICBM Launch Facilities were modified and built to have the capability to receive commands from ALCS. With ALCS standing alert around-the-clock, the Soviets could no longer successfully launch a Minuteman LCC decapitation strike. Even if the Soviets attempted to do so, EC-135s equipped with the ALCS could fly overhead and launch the remaining Minuteman ICBMs in retaliation.

With the ALCS on alert, the Soviet war planning was complicated by forcing them to target not only the 100 LCCs, but also the 1,000 silos with more than one warhead in order to guarantee destruction. This would have required upwards of 3,000 warheads to complete such an attack. The odds of being successful in such an attack on the Minuteman ICBM force would have been extremely low.

The ALCS is operated by airborne missileers from the Air Force Global Strike Command's (AFGSC) 625th Strategic Operations Squadron (STOS) and United States Strategic Command (USSTRATCOM). The weapon system is also located on board the United States Navy's E-6B Mercury. The ALCS crews are integrated into the battle staff of the USSTRATCOM "Looking Glass" Airborne Command Post (ABNCP) and are on alert around-the-clock. Although the Minuteman ICBM force has been reduced since the end of the Cold War, the ALCS continues to act as a force multiplier by ensuring that some enemy cannot launch a successful Minuteman LCC decapitation strike.

Mobile Minuteman
Mobile Minuteman was a program for rail-based ICBMs to help increase survivability and for which the USAF released details on 12 October 1959. Minuteman Mobility Test Trains were first exercised from 20 June to 27 August 1960 at Hill Air Force Base, and the 4062nd Strategic Missile Wing (Mobile) was organized 1 December 1960. It was planned to include three missile train squadrons, each with 10 trains carrying 3 missiles per train. During the Kennedy/McNamara force reductions, the Department of Defense announced "that it has abandoned the plan for a mobile Minuteman ICBM. The concept called for 600 to be placed in service—450 in silos and 150 on special trains, each train carrying 5 missiles." Kennedy announced on 18 March 1961 that the 3 squadrons were to be replaced with "fixed-base squadrons", and Strategic Air Command discontinued the 4062nd Strategic Missile Wing on 20 February 1962.

Air-Launched ICBM
Air-Launched ICBM was a STRAT-X proposal in which SAMSO (Space & Missile Systems Organization) successfully conducted an Air Mobile Feasibility Test that airdropped a Minuteman 1b from a C-5A Galaxy aircraft from 20000 ft over the Pacific Ocean. The missile fired at 8000 ft, and the 10-second engine burn carried the missile to 20,000 feet again before it dropped into the ocean. Operational deployment was discarded due to engineering and security difficulties, and the capability was a negotiating point in the Strategic Arms Limitation Talks.

Emergency Rocket Communications System (ERCS)
From 1963 through 1991, the National Command Authority communication relay system included the Emergency Rocket Communication System (ERCS). Specially designed rockets called BLUE SCOUT carried radio-transmitting payloads high above the continental United States, to relay messages to units within line-of-sight. In the event of a nuclear attack, ERCS payloads would relay pre-programmed messages giving the "go-order" to SAC units.

BLUE SCOUT launch sites were located at Wisner, West Point and Tekamah, Nebraska. These locations were vital for ERCS effectiveness due to their centralized position in the US, within range of all missile complexes. In 1968, ERCS configurations were placed on the top of modified Minuteman II ICBMs (LGM-30Fs) under the control of the 510th Strategic Missile Squadron located at Whiteman Air Force Base, Missouri.

The Minuteman ERCS may have been assigned the designation LEM-70A.

Satellite launching role
The U.S. Air Force has considered using some decommissioned Minuteman missiles in a satellite launching role. These missiles would be stored in silos, for launch upon short notice. The payload would be variable and would have the ability to be replaced quickly. This would allow a surge capability in times of emergency.

During the 1980s, surplus Minuteman missiles were used to power the Conestoga rocket produced by Space Services Inc. of America. It was the first privately funded rocket, but saw only three flights and was discontinued due to a lack of business. More recently, converted Minuteman missiles have been used to power the Minotaur line of rockets produced by Orbital Sciences (nowadays Northrop Grumman Innovation Systems).

Ground and air launch targets
L-3 Communications is currently using SR-19 SRBs, Minuteman II Second Stage Solid Rocket Boosters, as delivery vehicles for a range of different re-entry vehicles as targets for the THAAD and ASIP interceptor missile programs as well as radar testing.

Operators
🇺🇸: The United States Air Force has been the only operator of the Minuteman ICBM weapons system, currently with three operational wings and one test squadron operating the LGM-30G. The active inventory in FY 2009 is 450 missiles and 45 Missile Alert Facilities (MAF).

Operational units
The basic tactical unit of a Minuteman wing is the squadron, consisting of five flights. Each flight consists of ten unmanned launch facilities (LFs) which are remotely controlled by a manned launch control center (LCC). A two-officer crew is on duty in the LCC, typically for 24 hours. The five flights are interconnected and status from any LF may be monitored by any of the five LCCs. Each LF is located at least three nautical miles (5.6 km) from any LCC.

Control does not extend outside the squadron (thus the 319th Missile Squadron's five LCCs cannot control the 320th Missile Squadron's 50 LFs even though they are part of the same Missile Wing). Each Minuteman wing is assisted logistically by a nearby Missile Support Base (MSB). If the ground-based LCCs are destroyed or incapacitated, the Minuteman ICBMs can be launched by airborne missileers utilizing the Airborne Launch Control System.

Active

 * 90th Missile Wing – "Mighty Ninety"
 * at Francis E. Warren AFB, Wyoming, (1 July 1963 – present)
 * Units:
 * 319th Missile Squadron – "Screaming Eagles"
 * 320th Missile Squadron – "G.N.I."
 * 321st Missile Squadron – "Greentails"
 * 150 missiles, 15 MAF – Launch sites
 * LGM-30B Minuteman I, 1964–74
 * LGM-30G Minuteman III, 1973–present
 * 91st Missile Wing – "Roughriders"
 * at Minot AFB, North Dakota (25 June 1968 – present)
 * Units:
 * 740th Missile Squadron – "Vulgar Vultures"
 * 741st Missile Squadron – "Gravelhaulers"
 * 742d Missile Squadron – "Wolf Pack"
 * 150 Missiles, 15 MAF – Launch sites
 * LGM-30B Minuteman I, 1968–72
 * LGM-30G Minuteman III, 1972–present
 * 341st Missile Wing
 * at Malmstrom AFB, Montana (15 July 1961 – present)
 * Units:
 * 10th Missile Squadron – "First Aces"
 * 12th Missile Squadron – "Red Dawgs"
 * 490th Missile Squadron – "Farsiders"
 * 150 Missiles, 15 MAF – Launch sites
 * LGM-30A Minuteman I, 1962–69
 * LGM-30F Minuteman II, 1967–94
 * LGM-30G Minuteman III, 1975–present
 * 625th Strategic Operations Squadron
 * at Offutt AFB, Nebraska

Historical

 * 44th Strategic Missile (later Missile) Wing "Black Hills Bandits"
 * Ellsworth AFB, South Dakota (24 November 1961 – 5 July 1994)
 * LGM-30B Minuteman I, 1963–73
 * LGM-30F Minuteman II, 1971–94
 * 66th Missile Squadron
 * 67th Missile Squadron
 * 68th Missile Squadron
 * 44th Missile Wing LGM-30 Minuteman Missile Launch Sites
 * Inactivated 1994 when Minuteman II phased out of inventory. All retired between 3 December 1991 and April 1994, with destruction of silos and alert facilities finishing in 1996.

 * 90th Missile Wing
 * 400th Missile Squadron (Converted to LGM-118A Peacekeeper in 1987. Inactivated 2005. Peacekeepers retired.)

 * 321st Strategic Missile (later Missile) Wing (later Group)
 * Grand Forks AFB, North Dakota (14 August 1964 – 30 September 1998)
 * LGM-30F Minuteman II, 1965–73
 * LGM-30G Minuteman III, 1972–98
 * 446th Missile Squadron
 * 447th Missile Squadron
 * 448th Missile Squadron
 * 321st Missile Wing LGM-30 Minuteman Missile Launch Sites
 * Inactivated by BRAC 1995; missiles reassigned to 341st SMW, however in 1995 it was decided to retire the Grand Forks missiles; the last missile was pulled from its silo in June 1998. Destruction of silos and control facilities began in October 1999; the last silo (H-22) was imploded 24 August 2001 (the last US silo destroyed per the 1991 START-I treaty).

 * 341st Missile Wing
 * 564th Missile Squadron (Inactivated 2008, WS-133B system retired, missiles recycled into inventory)

 * 351st Strategic Missile (later Missile) Wing
 * Whiteman AFB, Missouri (1 February 1963 – 31 July 1995)
 * LGM-30B Minuteman I, 1963–65
 * LGM-30F Minuteman II, 1965–95
 * 508th Missile Squadron
 * 509th Missile Squadron
 * 510th Missile Squadron
 * 351st Missile Wing LGM-30 Minuteman Missile Launch Sites
 * The 510th SMS operated Emergency Rocket Communication System (ERCS) missiles in addition to Minuteman II ICBMs. The 351st SMW was inactivated under START-I. The first silo was imploded on 8 December 1993 and the last on 15 December 1997.

 * 455th Strategic Missile Wing
 * Minot AFB, North Dakota (28 June 1962 – 25 June 1968)
 * LGM-30B Minuteman I, 1962–68
 * Replaced by the 91st Strategic Missile Wing in June 1968

 * Historical Airborne Launch Control System Units
 * 68th Strategic Missile Squadron (Ellsworth AFB, SD: 1967–1970)
 * 91st Strategic Missile Wing (Minot AFB, ND: 1967–1969)
 * 4th Airborne Command and Control Squadron (Ellsworth AFB, SD: 1970–1992)
 * 2nd Airborne Command and Control Squadron (Offutt AFB, NE: 1970–1994)
 * 7th Airborne Command and Control Squadron (Offutt AFB, NE: 1994–1998)
 * 625th Missile Operations Flight/USSTRATCOM (Offutt AFB, NE: 1998–2007)
 * Converted to the 625th Strategic Operations Squadron in 2007, where ALCS mission continues to this day

Support

 * 532d Training Squadron – Vandenberg AFB, California (Missile Maintenance Training and Missile Initial Qualification Course)
 * 315th Weapons Squadron – Nellis AFB, Nevada (ICBM Weapons Instructor Course)
 * 526th ICBM Systems Wing – Hill Air Force Base, Utah
 * 576th Flight Test Squadron – Vandenberg Air Force Base, California – "Top Hand"
 * 625th Strategic Operations Squadron – Offutt AFB, Nebraska

Replacement
A request for proposal for development and maintenance of a Ground Based Strategic Deterrent (GBSD) next-generation nuclear ICBM, was made by the US Air Force Nuclear Weapons Center, ICBM Systems Directorate, GBSD Division on 29 July 2016. The GBSD would replace MMIII in the land-based portion of the US Nuclear Triad. The new missile to be phased in over a decade from the late 2020s are estimated over a fifty-year life cycle to cost around $86 billion. Boeing, Lockheed Martin, and Northrop Grumman were competing for the contract.

On 21 August 2017, the US Air Force awarded 3-year development contracts to Boeing and Northrop Grumman, for $349 million and $329 million, respectively. One of these companies will be selected to produce this ground-based nuclear ICBM in 2020. In 2027, the GBSD program is expected to enter service and remain active until 2075.

On 14 December 2019, it was announced that Northrop Grumman had won the competition to build the future ICBM. Northrop won by default, as their bid was at the time the only bid left to be considered for the GBSD program (Boeing had dropped out of the bidding contest earlier in 2019). The US Air Force said: "The Air Force will proceed with an aggressive and effective sole-source negotiation." in reference to Northrop's bid.

Surviving decommissioned sites

 * Oscar One Alert Facility at Whiteman AFB
 * Delta One Alert Facility at Minuteman Missile National Historic Site
 * Delta Nine Silo at Minuteman Missile National Historic Site
 * Minuteman II missile Training Launch Facility at Ellsworth AFB
 * Oscar Zero Alert Facility at Ronald Reagan Minuteman Missile State Historic Site
 * November 33 Silo (topside only) at Ronald Reagan Minuteman Missile State Historic Site
 * Quebec-One Missile Alert Facility at Cheyenne, Wyoming (modified for Peacekeeper ICBM in 1986)

Preservation
The Minuteman Missile National Historic Site in South Dakota preserves a Launch Control Facility (D-01) and a launch facility (D-09) under the control of the National Park Service. The North Dakota State Historical Society maintains the Ronald Reagan Minuteman Missile Site, preserving a Missile Alert Facility, Launch Control Center and Launch Facility in the WS-133B "Deuce" configuration, near Cooperstown, North Dakota.

Comparable missiles

 * RS-28 Sarmat
 * DF-5
 * DF-41
 * PGM-17 Thor
 * R-36
 * RS-24 Yars
 * RT-2
 * RT-2PM2 Topol-M
 * UR-100N
 * Agni-VI

license: Creative Commons - Attribution Share-Alike - https://creativecommons.org/licenses/by-sa/4.0/

title: LGM-30 Minuteman


text:
Laurent-Désiré Kabila

Laurent-Désiré Kabila (27 November 1939 – 16 January 2001)  usually known as Laurent Kabila ( US: ), was a Congolese rebel and politician who served as the third President of the Democratic Republic of the Congo from 1997 until his assassination in 2001.

Kabila became known during the 1960s Congo Crisis as an opponent of Mobutu Sese Seko. He took part to the Simba rebellion and led the Communist-aligned Fizi rebel territory until the 1980s. In the 1990s, Kabila re-emerged as leader of the Alliance of Democratic Forces for the Liberation of Congo (ADFLC), a Rwandan and Ugandan-sponsored rebel group that invaded Zaire and overthrew Mobutu during the First Congo War from 1996 to 1997. Having now become the new president of the country, whose name was changed back to the Democratic Republic of the Congo, Kabila found himself in a delicate position as a puppet of his foreign backers. The following year, he ordered the departure of all foreign troops from the country following the Kasika massacre to prevent a potential coup, leading to the Second Congo War in which his former Rwandan and Ugandan allies began sponsoring several rebel groups to overthrow him. During the war, he was assassinated by one of his bodyguards, and was succeeded ten days later by his 29-year-old son Joseph.

Early life
Kabila was born to the Luba people in Baudouinville, Katanga Province, (now Moba, Tanganyika Province), or Jadotville, Katanga Province, (now Likasi, Haut-Katanga Province) in the Belgian Congo. His father was a Luba and his mother was a Lunda; his father's ethnicity was defining in the patriarchal kinship system. It is claimed that he studied abroad (political philosophy in Paris, got a PhD in Tashkent, in Belgrade and at last in Dar es Salaam), but no proof has been found or provided.

1960s Congo Crisis
Shortly after the Congo achieved independence in 1960, Katanga seceded under the leadership of Moïse Tshombe. Kabila organised the Baluba in an anti-secessionist rebellion in Manono. In September 1962 a new province, North Katanga, was established. He became a member of the provincial assembly and served as chief of cabinet for Minister of Information Ferdinand Tumba. In September 1963 he and other young members of the assembly were forced to resign, facing allegations of communist sympathies.

Kabila established himself as a supporter of hard-line Lumumbist Prosper Mwamba Ilunga. When the Lumumbists formed the Conseil National de Libération, he was sent to eastern Congo to help organize a revolution, in particular in the Kivu and North Katanga provinces. This revolution was part of the larger Simba rebellions happening in the provinces at the time. In 1965, Kabila set up a cross-border rebel operation from Kigoma, Tanzania, across Lake Tanganyika.

Association with Che Guevara
Kabila met Che Guevara for the first time in April 1965 where Guevara had appeared in the Congo with approximately 100 Cuban men who envisaged to bring about a Cuban-style revolution to overthrow the Congolese government. Guevara assisted Kabila and his rebel forces for a few months before Guevara judged Kabila (then age 26) as "not the man of the hour" he had alluded to, being too distracted and his men poorly trained and disciplined. This, in Guevara's opinion, accounted for Kabila showing up days late at times to provide supplies, aid, or backup to Guevara's men. Kabila preferred to spend most of his time at local bars or brothels instead of training his men or fighting the Congolese government forces. The lack of cooperation between Kabila and Guevara contributed to the suppression of the revolt in November that same year.

In Guevara's view, of all of the people he met during his campaign in Congo, only Kabila had "genuine qualities of a mass leader"; but Guevara castigated Kabila for a lack of "revolutionary seriousness". After the failure of the rebellion, Kabila turned to smuggling gold and timber on Lake Tanganyika. He also ran a bar and brothel in Kigoma, Tanzania.

Marxist mini-state (1967–1988)
In 1967, Kabila and his remnant of supporters moved their operation into the mountainous Fizi – Baraka area of South Kivu in the Congo, and founded the People's Revolutionary Party (PRP). With the support of the People's Republic of China, the PRP created a secessionist Marxist state in South Kivu province, west of Lake Tanganyika.

The PRP state came to an end in 1988 and Kabila disappeared and was widely believed to be dead. While in Kampala, Kabila reportedly met Yoweri Museveni, the future president of Uganda. Museveni and former Tanzanian President Julius Nyerere later introduced Kabila to Paul Kagame, who would become president of Rwanda. These personal contacts became vital in mid-1990s, when Uganda and Rwanda sought a Congolese face for their intervention in Zaire.

First Congo War
As Rwandan Hutu refugees fled to Congo (then Zaire) after the 1994 genocide in Rwanda, refugee camps along the Zaire-Rwanda border became militarized with Hutu militia vowing to retake power in Rwanda. The Kigali regime considered these militias as a security threat and was seeking a way to dismantle those refugee camps. After Kigali had expressed its security concerns to Kinshasa, requesting that refugee camps get moved further inside the country, and Kinshasa ignored these concerns, Kigali believed that only military option could solve the issue. However, a military operation inside Zaire was likely be seen by the international community as an invasion. A plan was put in place to foment a rebellion that would serve as a cover. The Alliance of Democratic Forces for the Liberation of Congo (AFDL) was then born with Rwanda's blessing, and with Kabila as its spokesperson.

By mid-1997, the AFDL had almost completely overrun the country and the remains of Mobutu's army. Only the country's decrepit infrastructure slowed Kabila's forces down; in many areas, the only means of transit were irregularly used dirt paths. Following failed peace talks held on board of the South African ship SAS Outeniqua, Mobutu fled into exile on 16 May.

The next day, from his base in Lubumbashi, Kabila declared victory and installed himself as president. Kabila suspended the Constitution and changed the name of the country from Zaire to the Democratic Republic of the Congo—the country's official name from 1964 to 1971. He made his grand entrance into Kinshasa on 20 May and was sworn in on 31 May, officially commencing his tenure as president.

Presidency (1997–2001)

Kabila had previously been a committed Marxist, but his policies at this point were social democratic. He declared that elections would not be held for two years, since it would take him at least that long to restore order. While some in the West hailed Kabila as representing a "new breed" of African leadership, critics charged that Kabila's policies differed little from his predecessor's, being characterised by authoritarianism, corruption, and human rights abuses. As early as late 1997, Kabila was being denounced as "another Mobutu". Kabila was also accused trying to set up a personality cult. Mobutu's former minister of information, Dominique Sakombi Inongo, was retained by Kabila; he branded Kabila as "the Mzee," and created posters reading "Here is the man we needed" (Voici l'homme que nous avions besoin) appeared all over the country.

By 1998, Kabila's former allies in Uganda and Rwanda had turned against him and backed a new rebellion of the Rally for Congolese Democracy (RCD) and the Movement for the Liberation of the Congo (MLC). Kabila found new allies in Angola, Namibia and Zimbabwe, and managed to hold on in the south and west of the country and by July 1999, peace talks led to the withdrawal of most foreign forces.

Assassination and trial
On 16 January 2001, Kabila was shot in his office at the Palais de Marbre and subsequently transported to Zimbabwe for medical treatment. The DRC's authorities managed to keep power, despite Kabila's assassination. The exact circumstances are still contested. Kabila reportedly died on the spot, according to DRC's then-health minister Leonard Mashako Mamba, who was in the next door office when Kabila was shot and arrived immediately after the assassination. The government claimed that Kabila was still alive, however, and he was flown to a hospital in Zimbabwe after he was shot so that DRC authorities could organize the succession.

The Congolese government announced that he had died of his wounds on 18 January. One week later, his body was returned to Congo for a state funeral and his son, Joseph Kabila, became president ten days later. By doing so, DRC officials were accomplishing the "verbal testimony" of the deceased President. Then Justice Minister Mwenze Kongolo and Kabila's aide-de-camp Eddy Kapend reported that Kabila had told them that his son Joseph, then number two of the army, should take over, if he were to die in office.

The investigation into Kabila's assassination led to 135 people, including four children, being tried before a special military tribunal. The alleged ringleader, Colonel Eddy Kapend (one of Kabila's cousins), and 25 others were sentenced to death in January 2003, but not executed. Of the remaining defendants, 64 were incarcerated, with sentences from six months to life, and 45 were exonerated. Some individuals were also accused of being involved in a plot to overthrow his son. Among them was Kabila's special advisor Emmanuel Dungia, former ambassador to South Africa. Many people believe the trial was flawed and the convicted defendants innocent; doubts are summarized in an Al Jazeera investigative film, Murder in Kinshasa.

In January 2021, DRC's President Félix Tshisekedi pardoned all those convicted in the murder of Laurent-Désiré Kabila in 2001. Colonel Eddy Kapend and his co-defendants, who have been incarcerated for 15 years, were released.

Personal life
He had at least nine children with his wife Sifa Mahanya: Josephine, Cécile, Fifi, Selemani, twins Jaynet and Joseph, Zoé, Anina and Tetia. He was also the alleged father of Aimée Kabila Mulengela whose mother is Zaïna Kibangula.

title: Laurent-Désiré Kabila