How is phenylketonuria cured?

Written by Yan Xin Liang
Pediatrics
Updated on September 20, 2024
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Phenylketonuria is an autosomal recessive genetic disease, primarily due to a mutation in the phenylalanine hydroxylase gene which leads to reduced enzymatic activity, causing the accumulation of phenylalanine and its metabolites in the body, thereby leading to this disease. The main manifestations include developmental intellectual disabilities, light skin and hair pigmentation, and a musty urine odor. Once diagnosed, immediate treatment is necessary, mainly using a low-phenylalanine formula milk. Generally, when orally administering low-phenylalanine formula milk, it is essential to monitor the phenylalanine levels in the blood. Since each patient has a different tolerance level for phenylalanine, periodic determination of blood phenylalanine concentration is required in the dietary treatment. Such patients can only be treated long-term in this way; it is not curable nor can it be completely eradicated; treatment can only alleviate the symptoms and involves long-term administration of a low-phenylalanine diet.

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Written by Yao Li Qin
Pediatrics
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Is phenylketonuria often misdiagnosed?

Phenylketonuria belongs to congenital hereditary metabolic disorders and is caused by enzyme deficiencies in the phenylalanine metabolic pathway. Misdiagnosis of phenylketonuria is not common; if the disease develops, meaning that the child has typical clinical manifestations, it is relatively easy to diagnose. However, once a child exhibits the typical clinical manifestations of phenylketonuria such as blood phenylalanine levels, by the time of diagnosis the child may already have varying degrees of neurological damage, meaning the child might already have intellectual disabilities. Therefore, in such cases, we cannot rely solely on clinical symptoms for diagnosis but should instead carry out newborn disease screening promptly after birth. By diagnosing and treating before any clinical symptoms appear, we can prevent the occurrence of neurological complications, allowing the child to grow and develop like a normal child.

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Written by Zeng Hai Jiang
Pediatrics
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Can phenylketonuria eat corn?

People with phenylketonuria can eat corn. Phenylketonuria is a hereditary metabolic disease that can be treated through dietary control. Once diagnosed with phenylketonuria, one must stop a natural diet and switch to a low-phenylalanine diet. When the concentration of phenylalanine in the blood drops to an ideal level, natural foods can be gradually reintroduced in small amounts, but the diet must still adhere to low-protein and low-phenylalanine standards. Corn mainly consists of starch and does not contain phenylalanine, so individuals with phenylketonuria can eat corn.

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Written by Yan Xin Liang
Pediatrics
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Clinical symptoms of phenylketonuria

The clinical symptoms of phenylketonuria generally include normal appearance at birth, with symptoms usually appearing between three to six months, and becoming more pronounced by the age of one. The most noticeable initial symptoms involve the nervous system; delayed intellectual development is prominent, with intelligence often below normal, along with behavioral abnormalities such as hyperactivity, depression, restlessness, and withdrawal. There could be minor epileptic seizures, and in some cases, increased muscle tone or exaggerated tendon reflexes. Regarding the skin, several months after birth, due to insufficient melanin synthesis, the child’s hair changes from black to yellow, the skin appears pale, and eczema is also relatively common. Additionally, the urine and sweat contain higher levels of phenylacetic acid, which can result in a distinctive mouse-like urine odor.

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Written by Zeng Hai Jiang
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Does phenylketonuria require lifelong dietary control?

Theoretically, phenylketonuria requires lifelong dietary control. Phenylketonuria is caused by a deficiency in phenylalanine hydroxylase in the metabolic pathway of phenylalanine, leading to disordered metabolism of phenylalanine in the liver. Phenylketonuria is the first genetic metabolic disease that can be managed through diet. Since natural foods all contain certain amounts of phenylalanine, once diagnosed, affected children should cease consuming natural diets and should be treated with a low-phenylalanine diet. Treatment with a low-phenylalanine formula should continue at least until the age of 12. When the concentration of phenylalanine in the blood is controlled at an ideal level, natural foods can gradually be reintroduced in small amounts. The reintroduction of food should still follow the principles of low protein and low phenylalanine. The types and amounts of food that each child can add vary individually and are related to the severity of the enzyme deficiency.

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Written by Quan Xiang Mei
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Does phenylketonuria cause liver dysfunction?

Phenylketonuria generally does not cause abnormalities in liver function. Phenylketonuria is a common amino acid metabolic disorder, mainly due to a deficiency of an enzyme in the phenylalanine metabolic pathway, preventing phenylalanine from being converted into tyrosine. This leads to the accumulation of phenylalanine and its keto acids, which are then excreted in large amounts in the urine. This disease is a relatively common genetic amino acid metabolic defect. Once diagnosed with phenylketonuria, the main treatment is a dietary therapy, which includes a low-phenylalanine diet. It is important during the upbringing of children to ensure that the child's living environment is quiet and comfortable. Therefore, in terms of prevention of the disease, it is important to avoid consanguineous marriage, conduct newborn screening, and focus on early detection and early treatment.