How to diagnose phenylketonuria?

Written by Yan Xin Liang
Pediatrics
Updated on April 03, 2025
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Phenylketonuria is a treatable hereditary metabolic disease, where our primary goal is early diagnosis and treatment. Currently, a universal newborn screening system has been widely implemented. The standard procedure requires that after three days of breastfeeding, peripheral blood is collected from the newborn's heel, dropped onto specialized blood collection filter paper, and, once dried, sent to a screening laboratory to measure the phenylalanine concentration. If the phenylalanine concentration exceeds the cutoff value, further differential diagnosis and confirmation are conducted. Treatment typically starts two to three weeks after birth, and the prognosis is good. Additionally, diagnostic tests for phenylketonuria include urine ferric chloride, 2,4-dinitrophenylhydrazine tests, urinary purine profile analysis, and tetrahydrobiopterin loading test. Another method is through DNA analysis.

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Written by Yan Xin Liang
Pediatrics
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How to diagnose phenylketonuria?

Phenylketonuria is a treatable hereditary metabolic disease, where our primary goal is early diagnosis and treatment. Currently, a universal newborn screening system has been widely implemented. The standard procedure requires that after three days of breastfeeding, peripheral blood is collected from the newborn's heel, dropped onto specialized blood collection filter paper, and, once dried, sent to a screening laboratory to measure the phenylalanine concentration. If the phenylalanine concentration exceeds the cutoff value, further differential diagnosis and confirmation are conducted. Treatment typically starts two to three weeks after birth, and the prognosis is good. Additionally, diagnostic tests for phenylketonuria include urine ferric chloride, 2,4-dinitrophenylhydrazine tests, urinary purine profile analysis, and tetrahydrobiopterin loading test. Another method is through DNA analysis.

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Written by Yan Xin Liang
Pediatrics
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Phenylketonuria patients lack phenylalanine hydroxylase.

Phenylketonuria is an autosomal recessive genetic disorder caused by mutations in the phenylalanine hydroxylase gene, leading to reduced enzyme activity and resulting in the accumulation of phenylalanine and its metabolic products in the body, causing the disease. Phenylketonuria is the most common congenital amino acid metabolism disorder, clinically presenting with intellectual developmental delays, lighter skin and hair pigmentation, and a musty urine odor. The disease is mainly caused by mutations in the phenylalanine hydroxylase gene, leading to reduced enzyme activity.

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Written by Yan Xin Liang
Pediatrics
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Does phenylketonuria affect intelligence?

Phenylketonuria is a common amino acid metabolic disease, primarily caused by a deficiency of phenylalanine hydroxylase in the metabolic pathway of phenylalanine, preventing phenylalanine from converting into tyrosine. This leads to the accumulation of phenylalanine and its ketones in the body, which are then excreted in large amounts through urine. Its clinical manifestations are not uniform. The main clinical characteristic is intellectual disability, thus it does affect intelligence. Additionally, it can present various neuropsychiatric symptoms such as increased muscle tone, hyperreflexia, agitation, hyperactivity, convulsions, etc. It can also lead to reduced skin pigmentation and yellowing of hair among other symptoms. This disease can impact intelligence.

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Written by Hu Qi Feng
Pediatrics
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The pathogenesis of phenylketonuria

Phenylketonuria is an amino acid metabolic disease caused by a deficiency of phenylalanine hydroxylase. Phenylalanine is an essential amino acid for the human body, and it is partially converted into tyrosine by phenylalanine hydroxylase. Due to the reduced activity of phenylalanine hydroxylase, phenylalanine cannot be transformed into tyrosine. This leads to extremely high concentrations of phenylalanine in the blood, cerebrospinal fluid, and tissues. Through alternative metabolic pathways, large amounts of phenylpyruvic acid, phenylacetic acid, phenyllactic acid, and others are produced. High concentrations of phenylalanine and its metabolic products can cause brain damage.

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Written by Wang Lin Zhong
Pediatrics
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Early symptoms of phenylketonuria

Phenylketonuria is a hereditary metabolic disease caused by a deficiency or low activity of phenylalanine hydroxylase. Its main clinical manifestations include very obvious developmental delays in children and significantly lower IQ than their peers, severely affecting the child's growth and development. Due to the lack of this enzyme, the increase of abnormal metabolic products affects brain function, leading to symptoms such as seizures, convulsions, increased muscle tone, as well as hyperactivity and restlessness in children. The skin becomes particularly dry, prone to eczema, appears pale, and the hair turns yellow. The urine has a distinct mouse-like odor. Once diagnosed, early treatment is essential to reduce the sequelae of brain damage. The earlier the treatment, the better the prognosis. For these children, a special formula is needed, which is low in phenylalanine.