Homocystinuria
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| Homocystinuria Classification and external resources | |
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| Homocysteine | |
| ICD-10 | E72.1 |
| ICD-9 | 270.4 |
| OMIM | 236200 |
| DiseasesDB | 5991 |
| MedlinePlus | 001199 |
| eMedicine | derm/708 |
| MeSH | D006712 |
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Overview
Homocystinuria, also known as Cystathionine beta synthase deficiency, is an inherited disorder of the metabolism of the amino acid methionine, often involving cystathionine beta synthase. It is an inherited autosomal recessive trait, which means a child needs to inherit the defective gene from both parents to be affected.
Presentation
This defect leads to a multisystemic disorder of the connective tissue, muscles, CNS, and cardiovascular system. Homocystinuria represents a group of hereditary metabolic disorders characterized by an accumulation of homocysteine in the serum and an increased excretion of homocysteine in the urine. Infants appear to be normal and early symptoms, if any are present, are vague.
Symptoms
- A family history of homocystinuria
- Nearsightedness
- Flush across the cheeks
- Tall, thin build
- Long limbs
- High-arched feet (pes cavus)
- Knock-knees (genu valgum)
- Pectus excavatum
- Pectus carinatum
- Mental retardation
- Psychiatric disease
- Eye anomalies:
- 90% have ectopia lentis
- Myopia
- Glaucoma
- Optic atrophy
- Seizure
- extensive atheroma formation at young age which affects many arteries but not the coronary arteries [1] [2]
Mortality/morbidity
The life expectancy of patients with homocystinuria is reduced only if untreated. It is known that before the age of 30, almost one fourth of patients die as a result of thrombotic complications (e.g. heart attack).
Treatment
No specific cure has been discovered for homocystinuria; however, many people are treated using high doses of vitamin B6 (also known as pyridoxine). Slightly less than 50% respond to this treatment and need to intake supplemental vitamin B6 for the rest of their lives. Those who do not respond require a low methionine diet, and most will need treatment with trimethylglycine. A normal dose of folic acid supplement and occasionally added cysteine in the diet is helpful.
Recommended diet
Low-protein food is recommended for this disorder, which requires food products low in particular types of amino-acid (i.e. methonine).
References
- ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
- ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X
See also
External links
Acknowledgement and Attribution Regarding Sources of Content
Some of the initial content on this page may be incorporated in part from copyleft sources in the public domain including wikis such as Wikipedia and AskDrWiki. Drug information for patients came from the The National Library of Medicine. Infectious disease information may have come from the Centers for Disease Control (CDC). Differential Diagnoses are drawn from clinicians as well as an amalgamation of 3 sources: 1.The Disease Database; 2. Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:3; 3. Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:7 .
