Phenylketonuria lacks what enzyme?

Written by Yan Xin Liang
Pediatrics
Updated on September 26, 2024
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Phenylketonuria is an autosomal recessive genetic disorder primarily caused by mutations in the phenylalanine hydroxylase gene. This leads to reduced activity of phenylalanine hydroxylase, accumulation of phenylalanine and its metabolites in the body, and the onset of the disease. Phenylketonuria is the most common congenital amino acid metabolism disorder. Clinically, it is mainly characterized by intellectual developmental delays, light skin and hair pigmentation, and a mousey urine odor. The incidence of this disease varies by ethnicity and region. In China, the incidence is approximately 1 in 11,000.

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Written by Yan Xin Liang
Pediatrics
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Do children with mild phenylketonuria need treatment?

Phenylketonuria is a common amino acid metabolic disease, primarily due to the deficiency of phenylalanine hydroxylase, preventing phenylalanine from being converted into tyrosine. This leads to the accumulation of phenylalanine and its keto acids in the body, which are then excreted in large amounts in the urine. It is a relatively common genetic amino acid metabolic disorder and is inherited as an autosomal recessive trait. Even in cases of mild symptoms, treatment is still required. The main treatment is a low-phenylalanine diet, which involves dietary control, as phenylalanine is an essential amino acid for protein synthesis. Special phenylalanine-formula milk powder is fed to infants, and at this stage, it is appropriate to add some complementary foods such as starchy vegetables and fruits, focusing on low-protein foods. The goal of dietary treatment is to maintain an appropriate concentration of phenylalanine in the blood.

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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
Pediatrics
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Can phenylketonuria be cured?

Once phenylketonuria is diagnosed, immediate treatment is necessary; the younger the age at which treatment is started, the better the prognosis. The main approach is to use a low phenylalanine formula milk for treatment. Once the blood phenylalanine concentration has decreased to the desired level, we can gradually begin adding small amounts of natural diet. For small infants, breast milk is preferred since it contains much less phenylalanine than cow's milk. For older infants, additions such as cow's milk, porridge, noodles, and eggs are acceptable, but supplements should still follow the principle of being low in protein and phenylalanine. The amount and frequency of these additions should be determined based on the phenylalanine concentration, as too high or too low levels can affect growth and development. This condition can only be managed by controlling symptoms and maintaining blood phenylalanine levels. Long-term treatment is required; it cannot be cured, only controlled.

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Written by Yan Xin Liang
Pediatrics
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Phenylketonuria has what symptoms?

Phenylketonuria is an autosomal recessive genetic disorder. It is the most common congenital amino acid metabolism disorder. Its main clinical characteristics include intellectual disability, light skin and hair pigmentation, and a mousy urine odor. This name arises from the excretion of large amounts of phenylketonic acid metabolites in children's urine, which leads to the characteristic odor. Typically, affected children appear normal at birth, but symptoms usually begin to appear between three to six months of age, with most significant symptoms evident by one year. The most prominent issue is delayed intellectual development, with intelligence quotients often falling below normal. Skin pigmentation usually becomes lighter several months after birth due to insufficient melanin synthesis, resulting in hair turning from black to yellow and a paler skin complexion. Additionally, a distinct mousy body odor is produced due to the excretion of excessive phenylacetic acid in urine and sweat.

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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.