How long does it take for phenylketonuria to manifest?

Written by Zeng Hai Jiang
Pediatrics
Updated on February 18, 2025
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Phenylketonuria is a common amino acid metabolic disease. Most infants appear normal at birth and do not show any specific clinical symptoms during the neonatal period, although some newborns may experience symptoms such as feeding difficulties, vomiting, or irritability. Symptoms of phenylketonuria gradually appear in the first three months after birth, including changes such as hair turning from black to yellow, skin whitening, delayed growth and intellectual development, seizures, hyperactive reflexes, eczema, etc. The sweat and urine of affected children will have a mouse-like odor.

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Written by Yan Xin Liang
Pediatrics
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Phenylketonuria is caused by how?

Phenylketonuria is caused by how? It is an autosomal recessive genetic disease, mainly due to a mutation in the phenylalanine hydroxylase gene, which leads to a reduction in the activity of phenylalanine hydroxylase. Phenylalanine is an essential amino acid in the human body. The phenylalanine ingested is partly used for protein synthesis, and the rest is converted into tyrosine by the action of phenylalanine hydroxylase, with only a small amount of phenylalanine being converted into phenylpyruvic acid through a minor metabolic pathway under the action of transaminase. Due to the reduced activity of phenylalanine hydroxylase, phenylalanine cannot be converted into tyrosine, resulting in an extremely high concentration of phenylalanine in the blood, cerebrospinal fluid, and tissues. Through a bypass metabolism, a large amount of phenylpyruvic acid, phenylacetic acid, phenyllactic acid, and p-hydroxyphenylacetic acid are produced. High concentrations of phenylalanine and its metabolites thus lead to brain damage. Due to the synthesis disorder of tyrosine, this also leads to symptoms such as light skin and hair pigmentation.

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Is phenylketonuria characterized only by pale facial skin?

Phenylketonuria is a common amino acid metabolic disorder. It is primarily due to the deficiency of phenylalanine hydroxylase, which prevents the conversion of phenylalanine to tyrosine, leading to a series of clinical symptoms. These can manifest as intellectual disability, neuropsychiatric symptoms, eczema, skin scratching, pigment loss, and a musty odor. The skin whiteness mentioned is not merely facial pallor; it affects the entire skin because the benefits of tyrosine are reduced, leading to decreased melanin synthesis. Consequently, the hair of affected children can also be lighter and tend to be brown.

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How is phenylketonuria tested?

Phenylketonuria is a treatable inherited metabolic disease, and early diagnosis is essential for early treatment. Currently, we have generally implemented a newborn disease screening system that requires collecting peripheral blood by pricking the heel of newborns after three days of breastfeeding, dropping the blood onto specialized filter paper and sending it to a screening laboratory for phenylalanine concentration measurement. If the concentration exceeds the confirmed value, further differential diagnosis and confirmation are needed. If treatment can begin early, especially within two to three weeks after birth, the prognosis is generally good. Normally, the concentration is less than 120 µmol/L; a fetal concentration of 1200 µmol/L would be considered mild phenylketonuria.

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Written by Yan Xin Liang
Pediatrics
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Phenylketonuria is a disease.

Phenylketonuria is an autosomal recessive genetic disorder resulting from mutations in the phenylalanine hydroxylase gene, leading to reduced enzyme activity and the accumulation of phenylalanine and its metabolic products in the body, thereby causing this disease. Phenylketonuria is the most common congenital amino acid metabolic disorder, clinically characterized by intellectual developmental delays, light skin and hair pigmentation, and a mouse-like urine odor. The incidence of the disease varies by race and region, with an incidence rate in China of about 1 in 11,000. Phenylalanine is an essential amino acid for the human body, but due to reduced activity of phenylalanine hydroxylase, phenylalanine cannot be converted into tyrosine, leading to extremely high concentrations of phenylalanine in the blood, cerebrospinal fluid, and tissues. Abnormal metabolism produces a large amount of phenylpyruvic acid, phenylacetic acid, phenyllactic acid, and p-hydroxyphenylacetic acid, along with high concentrations of phenylalanine and its metabolic products, causing brain damage and corresponding symptoms.

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Written by Zeng Hai Jiang
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Can phenylketonuria be detected before a newborn is born?

Phenylketonuria can be screened prenatally before the birth of a newborn. The procedure involves genetic screening using amniotic fluid drawn through amniocentesis between the 16th and 20th week of pregnancy. Phenylketonuria is an autosomal recessive hereditary disease, greatly associated with chromosomal abnormalities. If chromosomal abnormalities are detected through amniocentesis, indicating the presence of pathogenic genes, it confirms that the fetus will be born with phenylketonuria. If both parents carry the relevant genes, prenatal screening is still necessary to rule out the risk of the disease in the fetus.