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Órgano Oficial del Instituto Nacional de Pediatría
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2012, Number 6

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Acta Pediatr Mex 2012; 33 (6)

Biochemical evaluation of phenylketonuria (PKU): from diagnosis to treatment

Belmont-Martínez L, Fernández-Lainez C, Ibarra-González I, Guillén-López S, Monroy- Santoyo S, Vela-Amieva M
Full text How to cite this article

Language: Spanish
References: 12
Page: 296-300
PDF size: 76.45 Kb.


Key words:

Phenylketonuria (PKU), tyrosine levels, hyperphenylalaninemia, phenylalanine, biochemical control.

ABSTRACT

Non treated phenylketonuria (PKU) has serious consequences such as growth retardation and intellectual impairment along with symptoms like erythematous eczema, fair skin and hair, seizures, autistic conduct and aggressive behavior.
Pre-symptomatic biochemical diagnosis consists of identifying patients by blood phenylalanine (Phe) quantification through newborn screening. The confirmation is based on determining serum Phe and tyrosine levels.
There is a wide spectrum of hyperphenylalaninemia clinical presentation, which ranges from mild forms which do not require nutritional treatment to the most severe form of the disease known as classic PKU.
The aim of treatment is to avoid irreversible neurological impairment by stabilizing blood Phe level and keeping it within therapeutic concentration range.
Once PKU diagnosis has been established, there are several criteria to decide when it is necessary to initiate treatment, we start it if Phe level is ≥ 360 micromol/L (6 mg/L).
Besides periodical Phe and Tyr testing, biochemical follow-up includes the measurement of necessary elements that guarantee normal physical and intellectual development such as selenium, zinc, B12 vitamin, folates, iron and long chain fatty acids. Clinical context is as important as biochemical status so periodic evaluation of nutritional, medical, social and psychological aspects should be included.


REFERENCES

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  2. Blau N, van Spronsen FJ, Levy HL. Phenylketonuria. Lancet 2010;376:1417-27.

  3. Blau N, Burton BK, Thöny, van Spronsen FJ, Waisbren S. Phenylketonuria and BH4 Deficiencies. Bremen, UNI-MED Verlag, 2010.

  4. National Institutes of Health Consensus Development Conference Statement: Phenylketonuria: Screening and Management, October 16-18,2000. Pediatrics 2001;108:972-82.

  5. Feillet F, van Spronsen FJ, MacDonald A. Challenges and pitfalls in the management of phenylketonuria. Pediatrics 2010;126:333-41.

  6. Acosta PB, Malaton MK. Nutrition management of patients with inherited disorders of aromatic amino acid metabolism. In: Acosta Pb (Ed). Nutrition management of patients with inherited metabolic disorders. Atlanta, USA: Jones & Bartlett Inc.; 2010. p. 119-74.

  7. van Spronsen FJ, Burgard P. The truth of treating patients with phenylketonuria after childhood: The need for a new guideline. J Inherit Metab Dis 2008;31:673-9.

  8. Cotugno G, Nicolo R, Cappelletti S, Goffredo BM, Vici CD, Giommo VD. Adherence to diet and quality of life in patients with phenylketonuria. Acta Paediatr 2011;100(8):1144-9.

  9. ten Hoedt AE, de Sonneville LMJ, Francois B, ter Horst NM, Janssen MCH, Rubio-Gozalbo ME, et al. High phenylalanine levels directly affect mood and sustained attention in adults with phenylketonuria: a randomised, double blind, placebocontrolled, crossover trial. J Inherit Metab Dis 2011;34:165-71.

  10. Burton BK, Bausell H, Katz R, Laduca H, Sullivan C. Sapropterin therapy increases stability of blood phenylalanine levels in patients with BH4-responsive phenylketonuria (PKU). Mol Genet Metab 2010;101:110-4.

  11. Singh RH, Quirk ME, Douglas TD, Brauchla MC. BH4 therapy impacts the nutrition status and intake in children with phenylketonuria: 2-year follow-up. J Inherit Metab Dis 2010;33:689-95.

  12. Camfield CS, Joseph M, Hurley T, Campbell K, Sanderson S, Camfield PR. Optimal management of PKU: a centralized expert team is more successful than a descentralized model of care. J Pediatr 2004;145:53-7.




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Acta Pediatr Mex. 2012;33