How is phenylketonuria diagnosed?

Written by Yan Xin Liang
Pediatrics
Updated on September 11, 2024
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How is phenylketonuria diagnosed?

Firstly, we start with screening, which is usually done when the newborn is 3 to 7 days old by heel prick to collect peripheral blood, which is then dropped onto specialized filter paper for the determination of phenylalanine concentration. If the concentration of phenylalanine is above the cutoff value, further determination of phenylalanine concentration is conducted. The normal concentration is less than 120 umol/L. If the concentration of phenylalanine is greater than 1200 umol/L, it suggests severe phenylketonuria. Moderate levels are above 360 umol/L, and mild levels are above 120 umol/L but less than 360 umol/L.

Furthermore, diagnosis can be confirmed through DNA analysis, currently available tests include screening for mutations in the phenylalanine hydroxylase gene.

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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.

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Written by Yan Xin Liang
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Phenylketonuria positive means what?

Phenylketonuria is an autosomal recessive inherited disease and is the most common congenital amino acid metabolism disorder. Generally, if the activity of phenylalanine hydroxylase in the body is reduced, or if there is a deficiency in its coenzyme tetrahydrobiopterin, the concentration of phenylalanine in the blood and tissues will increase, and phenylpyruvic acid, phenylacetic acid, and phenyllactic acid in the urine will also increase. Generally, newborns may not show any special clinical features at first. Often, the first test results may be high due to maternal influence or dietary factors, which can cause these elevated indicators in newborns. If the second test is normal, there usually isn’t a significant problem. A third test can also be performed; if the third test still shows no issues, then phenylketonuria can be ruled out. Generally, if phenylketonuria is diagnosed, it should be treated promptly and properly.

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Written by Zeng Hai Jiang
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Can phenylketonuria cause hair to turn white?

Phenylketonuria is caused by a mutation in the phenylalanine hydroxylase gene, resulting in reduced or lost enzyme activity, and a metabolic disorder of phenylalanine in the liver. Children with phenylketonuria lack phenylalanine hydroxylase, leading to reduced tyrosine and normal metabolic products. The content of phenylalanine in the blood increases, secondary metabolic pathways are enhanced, producing phenylpyruvic acid, phenylacetic acid, and phenyllactic acid, which are excreted in large amounts in the urine. High concentrations of phenylalanine and its abnormal metabolic products inhibit tyrosinase, leading to disturbances in melanin synthesis. Therefore, untreated children will gradually show changes in hair color from black to yellow and skin lightening after three months.

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Written by Zeng Hai Jiang
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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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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.