What is the probability of phenylketonuria?

Written by Yan Xin Liang
Pediatrics
Updated on September 07, 2024
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Phenylketonuria is an autosomal recessive genetic disorder primarily caused by mutations in the phenylalanine hydroxylase gene, leading to reduced enzyme activity and the accumulation of phenylalanine and its metabolites in the body, resulting in the disease. Phenylketonuria is the most common congenital amino acid metabolism disorder, with clinical manifestations mainly including intellectual developmental delays, light skin and hair pigmentation, and a mouse urine odor. The incidence of the disease varies by race and region. In China, the incidence of phenylketonuria is approximately 1 in 11,000, meaning that about one in 11,000 children suffers from phenylketonuria.

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Written by Yan Xin Liang
Pediatrics
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How is phenylketonuria tested?

Phenylketonuria is a treatable inherited metabolic disease, and early diagnosis is essential for early treatment. Currently, we have generally implemented a newborn disease screening system that requires collecting peripheral blood by pricking the heel of newborns after three days of breastfeeding, dropping the blood onto specialized filter paper and sending it to a screening laboratory for phenylalanine concentration measurement. If the concentration exceeds the confirmed value, further differential diagnosis and confirmation are needed. If treatment can begin early, especially within two to three weeks after birth, the prognosis is generally good. Normally, the concentration is less than 120 µmol/L; a fetal concentration of 1200 µmol/L would be considered mild phenylketonuria.

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Written by Zeng Hai Jiang
Pediatrics
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Does phenylketonuria require a lifetime of special milk consumption?

Phenylketonuria does not require a lifetime of special milk consumption. It is the first genetically inherited metabolic disorder that can be treated through dietary control. Once diagnosed with phenylketonuria, one must stop a natural diet and begin treatment with a low-phenylalanine diet. The low-phenylalanine milk formula should be consumed at least until the age of 12. When the concentration of phenylalanine in the blood is controlled within the ideal range, it is possible to appropriately add a small amount of natural diet, adhering to principles of low protein and low phenylalanine.

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Written by Yan Xin Liang
Pediatrics
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Can phenylketonuria be cured?

Phenylketonuria is one of the few treatable genetic metabolic diseases. It strives for early diagnosis and treatment to avoid irreversible damage to the nervous system. Once diagnosed, aggressive treatment should be given. The younger the age at which treatment starts, the better the effect. The main approach is to use a low-phenylalanine formula milk. When the blood concentration drops to a normal level, natural diet can gradually be added in small amounts, with breast milk being the preferred choice, as it contains only one-third the phenylalanine of cow's milk. Larger infants can add cow's milk, porridge, noodles, eggs, etc. The added foods should also follow the principle of being low in protein and low in phenylalanine, because concentrations of phenylalanine that are too high or too low will affect growth and development. Low-phenylalanine treatment should continue at least until after puberty. Lifelong treatment is more beneficial for patients. This disease can only control symptoms, and lifelong treatment is the best; it cannot be completely cured.

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Written by Yan Xin Liang
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Phenylketonuria smells like mouse urine.

Phenylketonuria is a common amino acid metabolic disorder primarily caused by a deficiency of phenylalanine hydroxylase. This deficiency prevents phenylalanine from being converted to tyrosine, leading to the accumulation of phenylalanine and ketone bodies, which are then excreted in large amounts in the urine. This disease is relatively common among genetic amino acid metabolic disorders and is inherited as an autosomal recessive trait. Additionally, due to the lack of phenylalanine hydroxylase, phenylalanine is metabolized through another pathway, resulting in increased production of phenyllactic acid and phenylacetic acid, which are excreted through sweat and urine, giving off a mouse-like urine odor.

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Written by Tong Peng
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Does phenylketonuria have a distinctive facial appearance?

Phenylketonuria is characterized by a specific facial appearance, primarily presenting with pale skin and yellow hair. Some affected children may develop eczema due to a disruption in melanin synthesis, which results in a distinctive skin color. Additionally, there are neuropsychiatric abnormalities, such as intellectual disability, increased excitability, and heightened muscle tone. The urine of patients has a plastic-like smell, largely because phenylketonuria is a hereditary metabolic disease. Newborns exhibit hyperphenylalaninemia, but as harmful metabolites of phenylalanine are not present in high concentrations before feeding begins, initial conditions at birth are often normal. However, as diet is introduced and metabolite concentrations increase, specific clinical symptoms, including severe cases of epileptic seizures manifested as infantile spasms, nodding seizures, or other forms, become evident. Therefore, dietary management is essential in treatment.