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Carnitine palmitoyl transferase II deficiency, myopathic form

MedGen UID:
371584
Concept ID:
C1833508
Disease or Syndrome
Synonyms: CARNITINE PALMITOYLTRANSFERASE II DEFICIENCY, ADULT-ONSET; Carnitine palmitoyltransferase II deficiency, late-onset; CARNITINE PALMITOYLTRANSFERASE II DEFICIENCY, MYOPATHIC; Carnitine palmitoyltransferase II deficiency, myopathic, stress-induced; CPT II DEFICIENCY, MYOPATHIC; CPT II deficiency, myopathic, stress-induced; CPT2 DEFICIENCY, LATE-ONSET
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).
 
Gene (location): CPT2 (1p32.3)
 
Monarch Initiative: MONDO:0009704
OMIM®: 255110
Orphanet: ORPHA228302

Disease characteristics

Excerpted from the GeneReview: Carnitine Palmitoyltransferase II Deficiency
Carnitine palmitoyltransferase II (CPT II) deficiency is a disorder of long-chain fatty-acid oxidation. The three clinical presentations are lethal neonatal form, severe infantile hepatocardiomuscular form, and myopathic form (which is usually mild and can manifest from infancy to adulthood). While the former two are severe multisystemic diseases characterized by liver failure with hypoketotic hypoglycemia, cardiomyopathy, seizures, and early death, the latter is characterized by exercise-induced muscle pain and weakness, sometimes associated with myoglobinuria. The myopathic form of CPT II deficiency is the most common disorder of lipid metabolism affecting skeletal muscle and the most frequent cause of hereditary myoglobinuria. Males are more likely to be affected than females. [from GeneReviews]
Authors:
Thomas Wieser   view full author information

Additional descriptions

From OMIM
Carnitine palmitoyltransferase II deficiency is an inherited disorder of mitochondrial long-chain fatty acid oxidation. The myopathic form presents most frequently in children or young adults with muscle pain with or, in most cases, without myoglobinuria with elevation of serum creatine kinase precipitated by strenuous exercise, cold, fever, or prolonged fasting. Severity of attacks is highly variable. Myoglobinuria can cause kidney failure and death (summary by Deschauer et al., 2005 and Longo et al., 2006). See also the lethal neonatal (608836) and infantile (600649) forms of the disorder, which are also caused by mutation in the CPT2 gene.  http://www.omim.org/entry/255110
From MedlinePlus Genetics
The myopathic form is the least severe type of CPT II deficiency. This form is characterized by recurrent episodes of muscle pain (myalgia) and weakness and is associated with the breakdown of muscle tissue (rhabdomyolysis). The destruction of muscle tissue releases a protein called myoglobin, which is processed by the kidneys and released in the urine (myoglobinuria). Myoglobin causes the urine to be red or brown. This protein can also damage the kidneys, in some cases leading to life-threatening kidney failure. Episodes of myalgia and rhabdomyolysis may be triggered by exercise, stress, exposure to extreme temperatures, infections, or fasting. The first episode usually occurs during childhood or adolescence. Most people with the myopathic form of CPT II deficiency have no signs or symptoms of the disorder between episodes.

The severe infantile hepatocardiomuscular form of CPT II deficiency affects the liver, heart, and muscles. Signs and symptoms usually appear within the first year of life. This form involves recurring episodes of hypoketotic hypoglycemia, seizures, an enlarged liver (hepatomegaly), cardiomyopathy, and arrhythmia. Problems related to this form of CPT II deficiency can be triggered by periods of fasting or by illnesses such as viral infections. Individuals with the severe infantile hepatocardiomuscular form of CPT II deficiency are at risk for liver failure, nervous system damage, coma, and sudden death.

The lethal neonatal form of CPT II deficiency becomes apparent soon after birth. Infants with this form of the disorder develop respiratory failure, seizures, liver failure, a weakened heart muscle (cardiomyopathy), and an irregular heart beat (arrhythmia). Affected individuals also have low blood glucose (hypoglycemia) and a low level of ketones, which are produced during the breakdown of fats and used for energy. Together these signs are called hypoketotic hypoglycemia. In many cases, the brain and kidneys are also structurally abnormal. Infants with the lethal neonatal form of CPT II deficiency usually live for a few days to a few months.

Carnitine palmitoyltransferase II (CPT II) deficiency is a condition that prevents the body from using certain fats for energy, particularly during periods without food (fasting). There are three main types of CPT II deficiency: a lethal neonatal form, a severe infantile hepatocardiomuscular form, and a myopathic form.  https://medlineplus.gov/genetics/condition/carnitine-palmitoyltransferase-ii-deficiency

Clinical features

From HPO
Myalgia
MedGen UID:
68541
Concept ID:
C0231528
Sign or Symptom
Pain in muscle.
Hereditary myoglobinuria
MedGen UID:
44557
Concept ID:
C0027080
Finding
Presence of myoglobin in the urine.
Renal insufficiency
MedGen UID:
332529
Concept ID:
C1565489
Disease or Syndrome
A reduction in the level of performance of the kidneys in areas of function comprising the concentration of urine, removal of wastes, the maintenance of electrolyte balance, homeostasis of blood pressure, and calcium metabolism.
Rhabdomyolysis
MedGen UID:
19775
Concept ID:
C0035410
Pathologic Function
Breakdown of muscle fibers that leads to the release of muscle fiber contents (myoglobin) into the bloodstream.
Muscle spasm
MedGen UID:
52431
Concept ID:
C0037763
Sign or Symptom
Sudden and involuntary contractions of one or more muscles.
Muscle weakness
MedGen UID:
57735
Concept ID:
C0151786
Finding
Reduced strength of muscles.
Muscle stiffness
MedGen UID:
113151
Concept ID:
C0221170
Sign or Symptom
A condition in which muscles cannot be moved quickly without accompanying pain or spasm.

Term Hierarchy

CClinical test,  RResearch test,  OOMIM,  GGeneReviews,  VClinVar  
  • CROGVCarnitine palmitoyl transferase II deficiency, myopathic form
Follow this link to review classifications for Carnitine palmitoyl transferase II deficiency, myopathic form in Orphanet.

Recent clinical studies

Etiology

Yazıcı H, Ak G, Çelik MY, Erdem F, Yanbolu AY, Er E, Bozacı AE, Güvenç MS, Aykut A, Durmaz A, Canda E, Uçar SK, Çoker M
J Pediatr Endocrinol Metab 2024 Jan 29;37(1):33-41. Epub 2023 Nov 7 doi: 10.1515/jpem-2023-0298. PMID: 37925743
Joshi PR, Deschauer M, Zierz S
J Clin Neurosci 2019 Jan;59:32-36. Epub 2018 Nov 16 doi: 10.1016/j.jocn.2018.11.023. PMID: 30455135

Diagnosis

Yazıcı H, Ak G, Çelik MY, Erdem F, Yanbolu AY, Er E, Bozacı AE, Güvenç MS, Aykut A, Durmaz A, Canda E, Uçar SK, Çoker M
J Pediatr Endocrinol Metab 2024 Jan 29;37(1):33-41. Epub 2023 Nov 7 doi: 10.1515/jpem-2023-0298. PMID: 37925743
Çakar NE, Gör Z, Yeşil G
Ideggyogy Sz 2021 Mar 30;74(3-4):135-138. doi: 10.18071/isz.74.0135. PMID: 33938664
Joshi PR, Zierz S
Molecules 2020 Apr 13;25(8) doi: 10.3390/molecules25081784. PMID: 32295037Free PMC Article
Joshi PR, Deschauer M, Zierz S
J Clin Neurosci 2019 Jan;59:32-36. Epub 2018 Nov 16 doi: 10.1016/j.jocn.2018.11.023. PMID: 30455135
Rodrigues AC, Kang PB
Semin Pediatr Neurol 2016 Aug;23(3):242-247. Epub 2016 Oct 14 doi: 10.1016/j.spen.2016.10.008. PMID: 27989332

Therapy

Shima A, Yasuno T, Yamada K, Yamaguchi M, Kohno R, Yamaguchi S, Kido H, Fukuda H
Intern Med 2016;55(18):2659-61. Epub 2016 Sep 15 doi: 10.2169/internalmedicine.55.6288. PMID: 27629963

Prognosis

Tan YY, Fong WYN, Chan CJ, Chandran S
BMJ Case Rep 2022 Dec 19;15(12) doi: 10.1136/bcr-2022-251321. PMID: 36535739Free PMC Article
Çakar NE, Gör Z, Yeşil G
Ideggyogy Sz 2021 Mar 30;74(3-4):135-138. doi: 10.18071/isz.74.0135. PMID: 33938664
Joshi PR, Deschauer M, Zierz S
J Clin Neurosci 2019 Jan;59:32-36. Epub 2018 Nov 16 doi: 10.1016/j.jocn.2018.11.023. PMID: 30455135

Supplemental Content

Table of contents

    Clinical resources

    Practice guidelines

    • PubMed
      See practice and clinical guidelines in PubMed. The search results may include broader topics and may not capture all published guidelines. See the FAQ for details.

    Curated

    • ACMG ACT, 2022
      American College of Medical Genetics and Genomics, Newborn Screening ACT Sheet, Increased C16 and/or C18:1 Acylcarnitine, Carnitine Palmitoyltransferase II (CPT II) Deficiency and Carnitine Acylcarnitine Translocase (CACT) Deficiency, 2022
    • ACMG Algorithm, 2022
      American College of Medical Genetics and Genomics, Algorithm, C16 +/- C18:1 Elevated: CPT II or CACT, 2022

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