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Classical phenylketonuria(PKU)

MedGen UID:
199655
Concept ID:
C0751434
Disease or Syndrome
Synonym: Classic phenylketonuria
SNOMED CT: Classical phenylketonuria (7573000); Imbecilitus phenylpyruvica (7573000); Hyperphenylalaninemia, type I (7573000); Severe phenylalanine hydroxylase deficiency (7573000)
Modes of inheritance:
Autosomal recessive inheritance
MedGen UID:
141025
Concept ID:
C0441748
Intellectual Product
Source: Orphanet
A mode of inheritance that is observed for traits related to a gene encoded on one of the autosomes (i.e., the human chromosomes 1-22) in which a trait manifests in individuals with two pathogenic alleles, either homozygotes (two copies of the same mutant allele) or compound heterozygotes (whereby each copy of a gene has a distinct mutant allele).
 
Monarch Initiative: MONDO:0019259
OMIM®: 261600; 612349
Orphanet: ORPHA79254

Definition

Phenylketonuria (commonly known as PKU) is an inherited disorder that increases the levels of a substance called phenylalanine in the blood. Phenylalanine is a protein building block (an amino acid) that is obtained from eating certain foods (such as meat, eggs, nuts, and milk) and in some artificial sweeteners. If PKU is not treated, phenylalanine can build up to harmful levels in the body, causing intellectual disability and other serious health problems.

The signs and symptoms of PKU vary from mild to severe. The most severe form of this disorder is known as classic PKU. Infants with classic PKU appear normal until they are a few months old. Without treatment, these children develop permanent intellectual disability. Seizures, delayed development, behavioral problems, and psychiatric disorders are also common. Untreated individuals may have a musty or mouse-like odor as a side effect of excess phenylalanine in the body. Children with classic PKU tend to have lighter skin and hair than unaffected family members and are also likely to have skin disorders such as eczema.

Less severe forms of this condition, sometimes called variant PKU and non-PKU hyperphenylalaninemia, have a smaller risk of brain damage. People with very mild cases may not require treatment.

PKU can often be managed by following a diet that is low in phenylalanine. Since phenylalanine is found in all proteins, the PKU diet consists of avoiding meat, dairy, nuts, tofu, and other foods that are high in protein. Infants with PKU need to be fed with a low-protein formula. Affected individuals are often limited to certain fruits and vegetables and foods containing fats and sugars (such as butter, jelly, pasta, and potato chips). The artificial sweeter aspartame, which is found in diet soda and many other low-calorie items, should be avoided as it contains high amounts of phenylalanine. The amount of phenylalanine that is safe to consume is different for each person. Affected individuals should work with a health care professional to develop an individualized diet. 

Babies born to mothers who have PKU and are not following a low-phenylalanine diet have a significant risk of intellectual disability because they are exposed to very high levels of phenylalanine before birth. These infants may also have a low birth weight and grow more slowly than other children. They may also have heart defects or other heart problems, an abnormally small head size (microcephaly), and behavioral problems. Women with PKU who are not following a low-phenylalanine diet (and may have high levels of phenylalanine) also have higher risk of pregnancy loss.

 [from MedlinePlus Genetics]

Professional guidelines

PubMed

Çınar M, Kılıç Yıldırım G, Kocagil S, Çilingir O
J Pediatr Endocrinol Metab 2022 May 25;35(5):639-647. Epub 2022 Mar 30 doi: 10.1515/jpem-2022-0047. PMID: 35355500
Szypowska A, Franek E, J Grzeszczak W, Zięba M, Filipow W, Kabicz P, Więckowska B, Sykut-Cegielska J, Taybert J
Pediatr Endocrinol Diabetes Metab 2020;26(3):118-124. doi: 10.5114/pedm.2020.97464. PMID: 32901468
Trefz FK, Scheible D, Frauendienst-Egger G, Korall H, Blau N
Mol Genet Metab 2005 Dec;86 Suppl 1:S75-80. Epub 2005 Oct 20 doi: 10.1016/j.ymgme.2005.06.026. PMID: 16242984

Recent clinical studies

Etiology

Yılmaz BK, Baykan A, Kardaş F, Kendirci M
Mol Genet Metab 2023 Nov;140(3):107677. Epub 2023 Aug 2 doi: 10.1016/j.ymgme.2023.107677. PMID: 37544048
Erdol S, Bilgin H
J Pediatr Endocrinol Metab 2022 Apr 26;35(4):463-467. Epub 2022 Jan 27 doi: 10.1515/jpem-2021-0737. PMID: 35084144
Walkowiak D, Kaluzny L, Bukowska-Posadzy A, Oltarzewski M, Staszewski R, Moczko JA, Musielak M, Walkowiak J
Adv Med Sci 2019 Sep;64(2):409-414. Epub 2019 Aug 29 doi: 10.1016/j.advms.2019.08.001. PMID: 31473582
Kose E, Arslan N
Clin Nutr 2019 Feb;38(1):197-203. Epub 2018 Feb 15 doi: 10.1016/j.clnu.2018.01.034. PMID: 29433755
Motzfeldt K, Lilje R, Nylander G
Acta Paediatr Suppl 1999 Dec;88(432):25-7. doi: 10.1111/j.1651-2227.1999.tb01151.x. PMID: 10626572

Diagnosis

Vazquez-Agra N, Fernandez-Crespo S, Marques-Afonso AT, Cruces-Sande A, Barbosa-Gouveia S, Martinez-Olmos MA, Hermida-Ameijeiras A
Med Clin (Barc) 2023 May 12;160(9):385-391. Epub 2023 Jan 9 doi: 10.1016/j.medcli.2022.09.025. PMID: 36628809
Silawi M, Haqparast S, Tabei SM
Clin Lab 2016;62(3):311-6. doi: 10.7754/clin.lab.2015.150512. PMID: 27156318
Patay Z
Eur Radiol 2005 Nov;15(11):2284-303. Epub 2005 Jul 15 doi: 10.1007/s00330-005-2846-2. PMID: 16021451
Motzfeldt K, Lilje R, Nylander G
Acta Paediatr Suppl 1999 Dec;88(432):25-7. doi: 10.1111/j.1651-2227.1999.tb01151.x. PMID: 10626572
Yu JS
Postgrad Med J 1970 Jul;46(537):430-6. doi: 10.1136/pgmj.46.537.430. PMID: 4920277Free PMC Article

Therapy

Janssen LEF, Cassiman D, Brouwers MCGJ
Mol Genet Metab 2023 Nov;140(3):107701. Epub 2023 Sep 20 doi: 10.1016/j.ymgme.2023.107701. PMID: 37757598
Çınar M, Kılıç Yıldırım G, Kocagil S, Çilingir O
J Pediatr Endocrinol Metab 2022 May 25;35(5):639-647. Epub 2022 Mar 30 doi: 10.1515/jpem-2022-0047. PMID: 35355500
Huemer M, Födinger M, Bodamer OA, Mühl A, Herle M, Weigmann C, Ulmer H, Stöckler-Ipsiroglu S, Möslinger D
Mol Genet Metab 2008 May;94(1):46-51. Epub 2008 Jan 14 doi: 10.1016/j.ymgme.2007.12.001. PMID: 18249021
Huemer M, Huemer C, Möslinger D, Huter D, Stöckler-Ipsiroglu S
J Inherit Metab Dis 2007 Oct;30(5):694-9. Epub 2007 Jul 11 doi: 10.1007/s10545-007-0549-3. PMID: 17628756
Motzfeldt K, Lilje R, Nylander G
Acta Paediatr Suppl 1999 Dec;88(432):25-7. doi: 10.1111/j.1651-2227.1999.tb01151.x. PMID: 10626572

Prognosis

Janssen LEF, Cassiman D, Brouwers MCGJ
Mol Genet Metab 2023 Nov;140(3):107701. Epub 2023 Sep 20 doi: 10.1016/j.ymgme.2023.107701. PMID: 37757598
Aslan T, Yenenler-Kutlu A, Gerlevik U, Aktuğlu Zeybek AÇ, Kıykım E, Sezerman OU, Birgul Iyison N
J Biomol Struct Dyn 2022;40(19):9018-9029. Epub 2021 May 10 doi: 10.1080/07391102.2021.1921619. PMID: 33970801
Huemer M, Huemer C, Möslinger D, Huter D, Stöckler-Ipsiroglu S
J Inherit Metab Dis 2007 Oct;30(5):694-9. Epub 2007 Jul 11 doi: 10.1007/s10545-007-0549-3. PMID: 17628756
Motzfeldt K, Lilje R, Nylander G
Acta Paediatr Suppl 1999 Dec;88(432):25-7. doi: 10.1111/j.1651-2227.1999.tb01151.x. PMID: 10626572
Güttler F, Guldberg P
Acta Paediatr Suppl 1994 Dec;407:49-56. doi: 10.1111/j.1651-2227.1994.tb13451.x. PMID: 7766959

Clinical prediction guides

Yılmaz BK, Baykan A, Kardaş F, Kendirci M
Mol Genet Metab 2023 Nov;140(3):107677. Epub 2023 Aug 2 doi: 10.1016/j.ymgme.2023.107677. PMID: 37544048
Aslan T, Yenenler-Kutlu A, Gerlevik U, Aktuğlu Zeybek AÇ, Kıykım E, Sezerman OU, Birgul Iyison N
J Biomol Struct Dyn 2022;40(19):9018-9029. Epub 2021 May 10 doi: 10.1080/07391102.2021.1921619. PMID: 33970801
Walkowiak D, Kaluzny L, Bukowska-Posadzy A, Oltarzewski M, Staszewski R, Moczko JA, Musielak M, Walkowiak J
Adv Med Sci 2019 Sep;64(2):409-414. Epub 2019 Aug 29 doi: 10.1016/j.advms.2019.08.001. PMID: 31473582
Karagoz T, Coskun T, Ozalp I, Ozkaya E, Ersoy F
Indian Pediatr 2003 Sep;40(9):822-33. PMID: 14530542
Güttler F, Guldberg P
Acta Paediatr Suppl 1994 Dec;407:49-56. doi: 10.1111/j.1651-2227.1994.tb13451.x. PMID: 7766959

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