Why does phenylketonuria lead to intellectual disability?

Written by Yan Xin Liang
Pediatrics
Updated on April 27, 2025
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Phenylketonuria is a common amino acid metabolic disease, mainly due to the deficiency of phenylalanine hydroxylase, which prevents phenylalanine from being transformed into tyrosine, leading to the accumulation of phenylalanine and its keto acids. Due to the lack of tyrosine in the body, it affects the growth and development of the brain, resulting in intellectual developmental delays. Therefore, children with phenylketonuria often exhibit intellectual disabilities, as well as some psychiatric and neurological symptoms, such as increased muscle tone, restlessness, hyperactivity, abnormal behavior, and heightened excitability.

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Written by Yan Xin Liang
Pediatrics
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Can phenylketonuria be prevented?

Phenylketonuria belongs to a recessive hereditary metabolic disease; how can we take preventive measures? First, we must avoid consanguineous marriages. Second, we need to conduct newborn screening to achieve early diagnosis, early detection, and early treatment. Third, for pregnant women with a family history of this disease, it is mandatory to use DNA analysis or methods like amniotic fluid testing for prenatal diagnosis of their fetuses. Prevention is better than cure. By taking preventive measures early, the chances of complications occurring are greatly reduced. If a baby shows symptoms of newborn phenylketonuria, parents should not take it lightly and should actively cooperate with the treatment.

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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 Tong Peng
Pediatrics
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Does phenylketonuria have a distinctive facial appearance?

Phenylketonuria is characterized by a specific facial appearance, primarily presenting with pale skin and yellow hair. Some affected children may develop eczema due to a disruption in melanin synthesis, which results in a distinctive skin color. Additionally, there are neuropsychiatric abnormalities, such as intellectual disability, increased excitability, and heightened muscle tone. The urine of patients has a plastic-like smell, largely because phenylketonuria is a hereditary metabolic disease. Newborns exhibit hyperphenylalaninemia, but as harmful metabolites of phenylalanine are not present in high concentrations before feeding begins, initial conditions at birth are often normal. However, as diet is introduced and metabolite concentrations increase, specific clinical symptoms, including severe cases of epileptic seizures manifested as infantile spasms, nodding seizures, or other forms, become evident. Therefore, dietary management is essential in treatment.

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Written by Yan Xin Liang
Pediatrics
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The causes of phenylketonuria

Phenylketonuria is a common autosomal recessive genetic disorder, the most frequent primary clinical manifestation among congenital amino acid metabolic disorders. It is characterized by intellectual disability, pale skin and hair pigmentation, and a mouse urine-like odor. The main cause is that phenylalanine is an essential amino acid for the human body. The phenylalanine ingested is partly used for protein synthesis and partly converted to tyrosine by the action of phenylalanine hydroxylase, which is necessary for the synthesis of substances like adrenaline, melanin, and thyroxine. The disease is mainly due to a deficiency of phenylalanine hydroxylase, which inhibits the conversion of phenylalanine to tyrosine, resulting in increased concentrations of phenylalanine in the blood, cerebrospinal fluid, and various tissues. At the same time, due to the predominance of the main pathway, the enhancement of the secondary metabolic pathway leads to the deamination of phenylalanine by transaminase, producing a large amount of phenylpyruvic acid, which through oxidation produces a large amount of phenylacetic acid, phenyllactic acid, and p-hydroxyphenylpyruvic acid. These metabolic by-products are excreted in large quantities in the urine, and the high concentrations of phenylalanine and its by-products accumulate extensively in brain tissue, thereby causing damage to brain cells.

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Written by Hu Qi Feng
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How is phenylketonuria diagnosed?

Phenylketonuria screening is routinely conducted in China for all newborns. This involves pricking the heel to collect peripheral blood, which is then dropped on specialized filter paper and dried. The samples are sent to a screening laboratory for the measurement of phenylalanine concentration. If the concentration exceeds the threshold, further testing for phenylalanine is conducted. Normally, the concentration should be less than 120 micromoles per liter. Additionally, an analysis of the urinary purine profile can be performed.