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  • 1
    Electronic Resource
    Electronic Resource
    Isolated biotin-resistant 3-methylcrotonyl-CoA carboxylase deficiency: Long-term outcome in a case with neonatal onset (1996)
    Springer
    European journal of pediatrics 155 (1996), S. 568-572 
    Details
    ISSN: 1432-1076
    Keywords: Isolated 3-methylcrotonyl-CoA carboxylase deficiency ; Inborn errors of metabolism ; Biotin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A patient with early-onset 3-methylcrotonyl coenzyme A carboxylase (MCC) deficiency showing a severe clinical course is described. Abnormal eye and head movements suggestive of seizures were noticed soon after birth. Tonic convulsions at the age of 10 weeks led to admission. Urinary organic acid analysis using gas chromatography-mass spectrometry at 3 months of age revealed elevated concentrations of 3-hydroxyisovaleric acid (3HIVA) and 3-methylcrotonylglycine but normal levels of lactate, 3-hydroxypropionate and methylcitrate suggesting isolated MCC deficiency. This was confirmed by enzyme assays in lymphocytes and cultured skin fibroblasts: MCC activity was virtually undetectable whereas activities of propionyl-CoA and pyruvate carboxylases were within the normal range. A low protein (0.8–1.5 g/kg/day) diet supplemented with a leucine-free amino acid mixture resulted in a marked decrease of 3HIVA excretion.l-Carnitine and biotin administration had no effect on the clinical condition or metabolite exretion. Supplementation with glycine resulted in only a temporary fall of 3HIVA excretion and was therefore discontinued.l-Carnitine therapy was reintroduced later because of secondary carnitine deficiency. Compliance with treatment was poor until the age of 27 months resulting in a severe episode with seizures and coma. The general clinical condition of the patient was always good but his psychomotor development was delayed and seizures were not continuously under good control due to poor therapy compliance. The boy is now 10.5 years old and attending a school for children with learning handicaps.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01957906
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  • 2
    Electronic Resource
    Electronic Resource
    Long-term follow up of a new case of hawkinsinuria (1999)
    Springer
    European journal of pediatrics 158 (1999), S. 578-582 
    Details
    ISSN: 1432-1076
    Keywords: Key words Hawkinsinuria ; 4-hydroxycyclohexylacetic acid ; Tyrosyluria ; Chronic metabolic acidosis ; Growth retardation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Hawkinsinuria is a rarely diagnosed autosomal dominantly transmitted inborn error of tyrosine metabolism with impaired conversion of 4-hydroxyphenylpyruvate to homogentisate. As a consequence of the defective 4-hydroxyphenylpyruvate dioxigenase activity, large amounts of the unusual, ninhydrin-positive amino acid hawkinsin and later on in life 4-hydroxycyclohexylacetic acid are formed and excreted. Clinically the disease is characterised mainly by chronic metabolic acidosis and severe growth retardation as a result of protein overload. As the ability to form 4-hydroxycyclohexylacetic acid and thereby to cope with the still not very well defined reactive and toxic intermediates increases, clinical symptoms vanish. We report here a new patient with hawkinsinuria having experienced a series of admissions because of unclear hepatopathy, growth retardation, and renal tubular acidosis. Conclusion Prolonged tyrosyluria in the newborn and young baby should cause the clinical chemist not only to exclude tyrosinaemia, galactosaemia, and fructose intolerance but also to look carefully for hawkinsin in the aminoacid chromatogram.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004310051151
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  • 3
    Electronic Resource
    Electronic Resource
    Late-onset holocarboxylase synthetase-deficiency: pre- and post-natal diagnosis and evaluation of effectiveness of antenatal biotin therapy (1998)
    Springer
    European journal of pediatrics 157 (1998), S. 570-575 
    Details
    ISSN: 1432-1076
    Keywords: Key words Holocarboxylase synthetase deficiency ; Biotin therapy ; Prenatal diagnosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The clinical and biochemical findings in a family with late-onset holocarboxylase synthetase (HCS) deficiency are described. The index patient had two life-threatening episodes of metabolic decompensation at the age of 13 and 18 months with ketotic hypoglycaemia, vomiting and progressive loss of consciousness. The child recovered without biotin therapy. Organic aciduria characteristic of multiple carboxylase deficiency (MCD) was found, however, the key metabolites were only slightly elevated in some samples. Biotinidase deficiency was considered but excluded by the finding of normal plasma biotinidase activity. The correct diagnosis was made only at the age of 19 months when severe MCD was found in lymphocytes in the presence of normal plasma biotin concentration. HCS deficiency was confirmed by fibroblast studies. Biotin therapy (20 or 40 mg/day) prevented further episodes and normalized biochemical parameters with so far normal development. During two subsequent pregnancies, 10 mg biotin/day was administered to the mother from the 20th week of gestation. At delivery plasma biotin in cord blood samples was 3–4 times higher than in maternal plasma. The 2nd child was unaffected. In the 3rd pregnancy prenatal diagnosis was performed at 16 weeks of gestation. The concentration of methylcitrate in amniotic fluid was within the normal range and that of 3-hydroxyisovalerate only slightly elevated. However, enzyme assays in cultured amniotic fluid cells were consistent with an affected fetus. At birth, carboxylase activities in lymphocytes of this newborn were only moderately decreased to 37% of mean normal. HCS deficiency was confirmed postnatally in fibroblasts. Development remains normal on biotin therapy (20 mg/day). Conclusion Prenatal diagnosis in families with milder forms of HCS deficiency has to be performed by enzyme assays in cultured amniotic cells since organic acid analysis of amniotic fluid may be inconclusive in affected fetuses. Biotin administered prenatally is effectively taken up by the fetus and prevents functional deficiency of the carboxylases in an affected newborn.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004310050881
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  • 4
    Electronic Resource
    Electronic Resource
    Metabolic stroke in isolated 3-methylcrotonyl-CoA carboxylase deficiency (1999)
    Springer
    European journal of pediatrics 158 (1999), S. 730-733 
    Details
    ISSN: 1432-1076
    Keywords: Key words Organic aciduria ; Branched-chain amino acids ; Acute infantile hemiplegia ; 3-methylcrotonyl-CoA carboxylase deficiency
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A mildly retarded infant with failure to thrive developed hypoglycaemia, focal seizures, respiratory failure and hemiparesis during a febrile episode at the age of 16 months. A brain scan was initially normal and showed hemilateral focal edema and gliosis at later stages. 3-Methylcrotonyl-CoA carboxylase deficiency was suggested by elevated urinary excretion of 3-hydroxyisovaleric acid and 3-methylcrotonylglycine, and confirmed by enzyme assays. The patient was treated with protein restriction and carnitine and remained stable during the following 5 years. Hemiparesis and some developmental delay persisted. Conclusion In acute focal brain disease, metabolic disorders must be considered. 3-Methylcrotonyl-CoA carboxylase deficiency adds to the list of possible causes of “metabolic stroke”.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004310051189
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  • 5
    Electronic Resource
    Electronic Resource
    Stridor as the major presenting symptom in riboflavin-responsive multiple acyl-CoA dehydrogenation deficiency (1997)
    Springer
    European journal of pediatrics 156 (1997), S. 800-802 
    Details
    ISSN: 1432-1076
    Keywords: Key words Inspiratory stridor  ;  Multiple acyl-CoA dehydrogenation deficiency  ;  Riboflavin therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Inspiratory stridor of unknown origin was the␣leading clinical symptom in an 11-month-old boy. The stridor increased over a period of 4 weeks, and assisted ventilation became necessary. Selective urinary screening by gas chromatography/mass spectrometry analysis revealed excretion of ethylmalonic and 3-OH-isovaleric acid and of n-isobutyryl-, n-2-methylbutyryl-, n-isovaleryl-, n-hexanoyl- and n-suberylglycine. Neither hypoglycaemia nor metabolic acidosis were noticed. Treatment with 200 mg of riboflavin per day led to a␣dramatic clinical improvement with restoration of normal respiration and an increase in muscular tone within 2 months. During this period, metabolite excretion in urine completely normalized. Riboflavin-sensitive multiple acyl-CoA dehydrogenation deficiency was confirmed in cultured fibroblasts. With riboflavin supplementation, the development of the child has been favourable, with normal school attendance now at an age of 9 years. Conclusion As respiratory symptoms might precede other symptoms in disorders of mitochondrial oxidation, we propose determination of urinary organic acids in all cases of unexplained laryngeal stridor.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004310050717
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  • 6
    Electronic Resource
    Electronic Resource
    Isolated biotin-resistant 3-methylcrotonyl-CoA carboxylase deficiency: long-term outcome in a case with neonatal onset (1996)
    Springer
    European journal of pediatrics 155 (1996), S. 568-572 
    Details
    ISSN: 1432-1076
    Keywords: Key words Isolated ; 3-methylcrotonyl-CoA carboxylase ; deficiency ; Inborn errors of ; metabolism ; Biotin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A patient with early-onset 3-methylcrotonyl coenzyme A carboxylase (MCC) deficiency showing a severe clinical course is described. Abnormal eye and head movements suggestive of seizures were noticed soon after birth. Tonic convulsions at the age of 10 weeks led to admission. Urinary organic acid analysis using gas chromatography-mass spectrometry at 3 months of age revealed elevated concentrations of 3-hydroxyisovaleric acid (3HIVA) and 3-methylcrotonylglycine but normal levels of lactate, 3-hydroxypropionate and methylcitrate suggesting isolated MCC deficiency. This was confirmed by enzyme assays in lymphocytes and cultured skin fibroblasts: MCC activity was virtually undetectable whereas activities of propionyl-CoA and pyruvate carboxylases were within the normal range. A low protein (0.8–1.5 g/kg/ day) diet supplemented with a leucine-free amino acid mixture resulted in a marked decrease of 3HIVA excretion. l-Carnitine and biotin administration had no effect on the clinical condition or metabolite excretion. Supplementation with glycine resulted in only a temporary fall of 3HIVA excretion and was therefore discontinued. l-Carnitine therapy was reintroduced later because of secondary carnitine deficiency. Compliance with treatment was poor until the age of 27 months resulting in a severe episode with seizures and coma. The general clinical condition of the patient was always good but his psychomotor development was delayed and seizures were not continuously under good control due to poor therapy compliance. The boy is now 10.5 years old and attending a school for children with learning handicaps. Conclusion Isolated MCC deficiency of early-onset is a rare condition exhibiting a more severe clinical course than the later-onset form described in most other cases. The prognostic value of 3 HIVA measurements in CSF and serum should be evaluated in future cases.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01957906
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  • 7
    Electronic Resource
    Electronic Resource
    Behandlung des hyperammonämischen Komas bei Neugeborenen und Säuglingen durch Hämodialyse oder Hämofiltration (1997)
    Springer
    Monatsschrift Kinderheilkunde 145 (1997), S. 714-718 
    Details
    ISSN: 1433-0474
    Keywords: Schlüsselwörter Hyperammonämie ; Harnstoffzyklusdefekte ; Organoazidurien ; Hämodialyse ; Hämofiltration ; Key words Hyperammonaemia ; Urea cycle disorders ; Organic acidemias ; Haemodialysis ; Haemofiltration
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Inborn errors of the urea cycle and of the organic acid metabolism can cause acute hyperammonemia in neonates which, if untreated, leads to coma, severe brain damage or death. These complications, however, can be prevented by proper diagnosis and early therapeutic intervention. Rapid decline in ammonia blood levels are essential and can be achieved by the following four therapeutic principles 1. restriction of protein intake (while maintaining essential amino acids), 2. reduction of protein catabolism by a hypercaloric diet, 3. activation of alternative pathways of ammonia elimination, and 4. elimination of ammonia from the circulation by dialysis. We report on 4 cases who were submitted because of acute hyperammonemic coma. All patients were treated immediately after diagnosis with hemodialysis (HD) or hemofiltration (HF). In all 4 patients blood ammonia levels were rapidly decreased to normal values leading to significant improvements of the neurologic state. The long term outcomes were, however, determined by the underlying metabolic disorder. Discussion: Our case reports confirm the effectiveness of HD and HF in the treatment of acute hyperammonemic coma. Since the diagnosis and the prognosis of metabolic disorders are rarely known at the time when the patient becomes symptomatic and needs therapy, any neonate with acute hyperammonemia should be referred to a special care unit where technical facilities for extracorporal dialysis are available.
    Notes: Zusammenfassung Das hyperammonämische Koma ist eine akut lebensbedrohliche Stoffwechselentgleisung. Die häufigsten kongenitalen Ursachen sind Enzymdefekte im Harnstoffzyklus und im Abbau von organischen Säuren. Die Frühdiagnose und eine sofortige aggressive Therapie sind die entscheidenden Voraussetzungen zur Vermeidung irreversibler Hirnschäden und letaler Verläufe. Das Therapieziel ist eine rasche Senkung des Ammoniaks und anderer neurotoxischer Metaboliten. Die therapeutischen Grundprinzipien beinhalten 1. eine restriktive Proteinzufuhr unter dem Erhalt essentieller Aminosäuren, 2. die Unterbrechung des Proteinkatabolismus mittels hochkalorischer Ernährung, 3. eine medikamentöse Aktivierung alternativer Wege der Stickstoffausscheidung sowie 4. apparative Blutreinigungsverfahren. Das optimale Dialyseverfahren ist umstritten. Wir haben 4 Neugeborene und Säuglinge in einem hyperammonämischen Koma im Rahmen von Stoffwechselerkrankungen mittels Hämodialyse oder Hämofiltration behandelt. Die Kasuistiken bestätigen die Effektivität und Komplikationsarmut beider Verfahren. Diskussion: In der Behandlung von lebensbedrohlichen Hyperammonämien bei Neugeborenen und Säuglingen sind Hämodialysen und Hämofiltrationen die Behandlungsmethoden der Wahl. Die invasive Blutreinigung ist mit einer konsequenten diätetischen und medikamentösen Therapie zu optimieren. Der prognostische Nutzen einer effizienten Blutreinigung bei ausgeprägter Hyperammonämie rechtfertigt einen unverzüglichen Transport in das nächstgelegene pädiatrische Dialysezentrum.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001120050173
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  • 8
    Electronic Resource
    Electronic Resource
    Erstmanifestation eines Abbaudefekts überlangkettiger Fettsäuren (VLCADD) mit letalem Ausgang (1998)
    Springer
    Monatsschrift Kinderheilkunde 146 (1998), S. 484-486 
    Details
    ISSN: 1433-0474
    Keywords: Schlüsselwörter Acyl-CoA-Dehydrogenase-Defekt überlangkettiger Fettsäuren ; Dikarbonazidurie ; Hypertrophische Kardiomyopathie ; Key words Very-long-chain acyl-CoA dehydrogenase deficiency ; Dicarboxylic aciduria ; Hypertrophic cardiomyopathy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Very-long-chain acyl-CoA dehydrogenase deficiency (VLCADD) is a rare disorder of the mitochondrial β-oxidation pathway. A female infant at 2,5 months of age presented with coma, cardiorespiratory arrest, hypoketotic hypoglycemia, hepatomegaly and hypertrophic cardiomyopathy. Urinary dicarboxylic acid profile suggested VLCADD. This diagnosis was confirmed by reduced enzyme activity in fibroblasts (20% of controls). After a few days the infant died of peritonitis caused by a penetrating ulcer of the duodenum. Discussion: A higher incidence of upper gastrointestinal ulcera is reported in patients with medium-chain acyl-CoA dehydrogenase deficiency (MCADD). VLCADD is characterized by early onset and high mortality due to cardiac disease. Gastrointestinal complications may contribute to or be directly responsible for death.
    Notes: Zusammenfassung Der Acyl-CoA-Dehydrogenasedefekt überlangkettiger Fettsäuren (very-long-chain acyl-CoA dehydrogenase deficiency, VLCADD) ist eine seltene Störung der mitochondrialen β-Oxidation. Wir berichten über einen weiblichen Säugling, bei dem im Alter von 2,5 Monaten im Rahmen eines Infekts Koma, Herz- und Atemstillstand, hypoketotische Hypoglykämie, Hepatomegalie und hypertrophe Kardiomyopathie auftraten. Ein charakteristisches Dikarbonsäurenmuster im Urin führte zu der Verdachtsdiagnose eines VLCADD, der durch den Nachweis einer auf 20% der Norm herabgesetzten Enzymaktivität in kultivierten Fibroblasten bestätigt wurde. Das Kind verstarb nach wenigen Tagen an einer Peritonitis infolge eines perforierten Ulcus duodeni. Diskussion: Ein gehäuftes Auftreten penetrierender Ulzera des oberen Magen-Darm-Trakts wurde bereits im Zusammenhang mit dem Abbaudefekt mittelkettiger Fettsäuren (medium-chain acyl-CoA dehydrogenase deficiency, MCADD) beschrieben. VLCADD ist charakterisiert durch frühe Erstmanifestation und eine hohe Mortalität, die v.a. auf die Kardiomyopathie zurückgeführt wird, zu der aber auch gastrointestinale Komplikationen beitragen können.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001120050290
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  • 9
    Electronic Resource
    Electronic Resource
    Seizures in a boy with succinic semialdehyde dehydrogenase deficiency treated with vigabatrin (γ-vinyl-GABA) (1996)
    Springer
    Journal of inherited metabolic disease 19 (1996), S. 313-318 
    Details
    ISSN: 1573-2665
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Succinic semialdehyde dehydrogenase (SSADH) deficiency is an autosomal recessive disease involving the catabolism of the neurotransmitter γ-amino-butyric acid (GABA). The main symptoms include retardation of psychomotor and language development, muscle hypotonia and non-progressive ataxia. Therapy consisting of approximately 75 mg/kg per day of vigabatrin, an irreversible inhibitor of GABA-transaminase, is reported to lead to some improvement of the clinical condition in affected patients. We report on a 12-year-old boy with SSADH deficiency who, when treated with 75 mg/kg per day of vigabatrin, showed marked amelioration of symptoms but also EEG changes and two generalized seizures. On discontinuing vigabatrin therapy, the seizures resolved and the EEG improved, but the patient's clinical condition deteriorated to its pre-treatment state. A stable EEG without the recurrence of seizures as well as renewed improvement of cognitive and behavioural functions was achieved with a reduced vigabatrin dose of 25 mg/kg per day. We conclude that vigabatrin in SSADH deficiency should be administered in a gradually increasing dosage combined with frequent evaluation of the clinical condition and the EEG.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01799261
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  • 10
    Electronic Resource
    Electronic Resource
    Clinically asymptomatic glutaric aciduria type I in a 4 5/12-year-old girl with bilateral temporal arachnoid cysts (1997)
    Springer
    Journal of inherited metabolic disease 20 (1997), S. 840-841 
    Details
    ISSN: 1573-2665
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1005348624375
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