[Anorexia nervosa and severe intermittent acute porphyria].
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Anorexia Nervosa↗
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[A CASE OF INTERMITTENT ACUTE PORPHYRIA IN A 52-YEAR-OLD WOMAN, TRIGGERED BY THE INGESTION OF AN ALLYL BARBITURATE].
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Barbiturates↗
[The diagnosis and treatment of patients with acute intermittent porphyria].
Four patients with acute intermittent porphyria (AIP) were treated and followed-up. It was established that in AIP urinary pigments have specific absorption spectra in the visible light range. Clinical manifestation and the severity of the disease course correlated with the amount of excretion of copro- and uroporphyrin and their characteristic spectrum of light absorption. It is concluded that of significance in the AIP pathogenesis is the level of formation of copro- and uroporphyrin isomers which may directly effect the nervous tissue and clinical manifestations of AIP. It is recommended to use plasmapheresis in biohemosorption by means of extracorporeal donor spleen.
Acute Disease↗
Acute intermittent porphyria: pathophysiology and treatment.
Acute intermittent porphyria is caused by an inherent error of porphyrin metabolism characterized by a deficiency of porphobilinogen deaminase and increased activity of delta-aminolevulinic acid synthase, key enzymes necessary for the biosynthesis of heme. During an attack patients may have abdominal pain, vomiting, muscle weakness, constipation and neuropsychiatric symptoms. In the majority of individuals the disease remains clinically latent throughout life. Various drugs and chemicals, hormones and nutritional factors predispose to clinical attacks, probably by inducing hepatic delta-aminolevulinic acid synthase. Avoidance of these substances is important in preventing attacks. Screening of family members to detect genetic carriers permits precautionary measures. Management of attacks includes symptomatic therapy, high carbohydrate intake and intravenous administration of hematin.
Acute Disease↗
Why is the patient with acute intermittent porphyria not light sensitive?
Acute intermittent porphyria (AIP) belongs to the group "inborn errors of metabolism". The disease is inherited as an autosomal dominant gene and characterized by abdominal, neurological and neuropsychiatric symptoms. The basic defect in AIP is assumed to be a mutation in the genetic system which controls the uroporphyrinogen-I-synthetase (UIS) activity. The UIS activity in erythrocytes is about 50% lower in gene carriers than among their non-porphyric siblings. The metabolic block in the haem synthesis is situated between porphobilinogen and uroporphyrinogen and leads to high levels of porphyrin precursors but no accumulation of porphyrins. Since the porphyrin precursors do not cause light sensitivity and tissue porphyrins are not markedly increased most patients with AIP are not light sensitive.
Child↗
Molecular forms of porphobilinogen deaminase in acute intermittent porphyria. A study by Western immunoblotting.
Acute intermittent porphyria is an inborn error of haem synthesis which is transmitted as a dominant character with variable phenotypic expression. The disorder is caused by a partial deficiency of porphobilinogen deaminase in all tissues so far studied. The nature of the enzymatic deficiency of porphobilinogen deaminase in haemolysates from patients with acute intermittent porphyria was examined by the use of monospecific antibody probes. In affected heterozygotes from three British pedigrees of diverse ancestry, the catalytic deficiency of porphobilinogen deaminase was accompanied by diminished enzyme protein, as determined by radial immunodiffusion. No evidence of functionally attenuated enzyme was demonstrable by kinetic studies. The molecular forms of the residual enzyme were investigated in red cell extracts and in lysed preparations of reticulocytes by a sensitive Western blotting procedure. This revealed the presence of reduced amounts of porphobilinogen deaminase polypeptide co-migrating with wild type enzyme (Mr approximately 40,000), and no evidence of variant forms in situ. The studies show that porphobilinogen deaminase deficiency in acute intermittent porphyria is commonly associated with a CRM-phenotype. The residual activity under these circumstances is thus related to expression of a single normal allele, since sensitive techniques detected neither aberrant nor degraded forms of the enzyme in erythroid tissues.
Acute Disease↗
[Acute pancreatitis associated with acute intermittent porphyria].
Pancreatic involvement associated with acute intermittent porphyria is rare. There were only nine cases reported until now which have pancreatic disease and AIP, one case with chronic pancreatitis, one with cystadenocarcinoma and chronic pancreatitis, one with transient macroamylasemia and the others with acute pancreatitis. The cause of these complications in these patients is uncertain. However, in our case, it is possible that AIP might have caused the acute pancreatitis, since this patient developed acute pancreatitis following the attack of AIP. It seems to be necessary to pay attention to the combination of these diseases.
Acute Disease↗
[Acute intermittent porphyria].
The clinical features of acute intermittent porphyria (AIP) are described in this chapter. AIP is inherited as an autosomal dominant pattern of inheritance. Prevalence in Japan is 1.5 in 100,000. Attacks are more frequent in women of 20s to 40s. The common clinical pattern of symptom involves acute abdominal pain, psychiatric disturbances, and acute neuropathy. The nerve biopsy shows segmental demyelination and axonal degeneration. Many small vacuolations are distinctively seen in all of the cell components of the nerve. Clinical diagnosis is not difficult when doctors keep the possibility of AIP in their minds in cases of abdominal pain, weakness and mental symptoms. The major trust of treatment is avoidance of acute attacks which is almost entirely dependent upon avoidance of porphyrogenic drugs. The intravenous administration of heme and glucose is important and effective therapy for acute attacks of porphyria.
Female↗
Detection of a R173W mutation in the porphobilinogen deaminase gene in the Nova Scotian "foreign Protestant" population with acute intermittent porphyria: a founder effect.
OBJECTIVES: Acute intermittent porphyria (AIP) is caused by mutations in the porphobilinogen deaminase (PBGD) gene that disrupt the function of the enzyme. Many mutations that lead to decreased PBGD activity have been described. An Arg to Trp substitution at codon 173 (CGG-->TGG in exon 10) and designated R173W, which leads to a CRIM-negative phenotype, has been reported in Swedish, Finnish, Scottish, and South African kindreds, and in a Nova Scotian proband with fatal AIP. In this work, we investigated the presence of this mutation in a Nova Scotian patient population presenting with AIP. DESIGN AND METHODS: Single-strand conformation polymorphism analysis and DNA sequencing by TA cloning and Sanger's dideoxy chain termination method, were used to confirm the maternal transmission of this mutation to the proband. The mutation also eliminates an Ncil (also Mspl) endonuclease restriction site, which allows for detection of the mutant allele by polymerase chain reaction amplification and restriction enzyme digestion. RESULTS: The family of the Nova Scotian proband and four other AIP kindreds showed the presence of the same mutation. These five families are descendants of German, Swiss, and French immigrants historically known as the "Foreign Protestants," who were recruited to Nova Scotia in the 1750s. CONCLUSION: In all these families, descent from one couple that settled in Nova Scotia in 1751 has been identified by genealogy research, consistent with a founder effect within this population. This is the first identified mutation in PBGD causing AIP that has been linked to a founder effect in descendants of an immigrant population to North America, and which could be traced to such a distant background, similar to the South African variegate porphyria mutation.
Adult↗
Coexistence of hereditary coproporphyria with acute intermittent porphyria.
A new form of acute hepatic porphyria with double genetic defect--deficiency of porphobilinogen deaminase and coproporphyrinogen oxidase--is described. Among 17 studied family members this double enzymatic deficiency was found in five individuals, deficiency of porphobilinogen deaminase in four, and deficiency of coproporphyrinogen oxidase in two. Only the proband had an attack of porphyria. Apart from the proband, all family members had normal urinary PBG excretion. Increased faecal coproporphyrin excretion was found in three people. The results obtained suggest that deficiency of porphobilinogen deaminase and coproporphyrinogen oxidase can be inherited independently. coproporphyrinogen oxidase can be inherited independently.
Adolescent↗
[Inappropriate secretion of antidiuretic hormone disclosing acute intermittent porphyria].
The authors report a case of acute intermittent porphyria in a 31-year old woman, revealed by inappropriate secretion of the antidiuretic hormone, a diagnosis confirmed by radioimmunoassay. Measurements of red cell urosynthetase made the diagnosis of porphyria certain and showed that the disease was familial, although clinically asymptomatic. Antidiuresis is not the only cause of hyponatraemia in acute intermittent porphyria. Similarly, psychic disorders are frequent in SIADH, but they are not necessarily due to acute intermittent porphyria.
Acute Disease↗
Acute intermittent porphyria: laboratory diagnosis by molecular methods.
Acute intermittent porphyria is a neurologic disorder caused by a partial deficiency of porphobilinogen (PBG) deaminase, the third enzyme in the synthetic pathway for heme. The isolation and characterization of the gene for PBG deaminase has brought molecular techniques for diagnosing the disease within reach. Over 60 mutations causing acute intermittent porphyria have been found, most of which are confined to one or several families. Because no single mutation accounts for more than a fraction of cases, screening techniques for locating and identifying unknown mutations are very important. Once a mutation has been characterized, testing of family members is straightforward, and gene carriers can be identified or excluded with greater accuracy than is possible with conventional biochemical tests.
DNA Mutational Analysis↗
Effects of administration of antioxidants in acute intermittent porphyria.
In order to elucidate the question of free radical involvement in acute porphyric crisis, antioxidants were administered to two acute intermittent porphyria patients with long-standing recurrent attacks. Clinical condition and urinary excretion of porphyrins and porphyrin precursors were monitored before, during and after an eight week therapy with daily doses of vitamin E, beta-carotene, ascorbic acid, selenium, vitamin Q, acetylcysteine, mannitol and carnitine. Blood cell trace element profiles were followed. The administration of the compound antioxidant formula was found not to further impair the clinical or biochemical conditions of the patients but the incidence of the recurrent crises or the severity of the symptoms were not positively affected. Aberrant blood cell trace element profiles with increased granulocyte manganese were normalized during treatment, on cessation of the therapy again resuming the abnormal pretreatment patterns, which may suggest an origin in oxidative stress. No correlation was observed between the concentration of granulocyte manganese and the excretion of 5-aminolaevulinic acid. Indications for participation of this porphyrin precursor in a radical generating process leading to generalized mitochondrial superoxide dismutase induction, as conceivably signalled by increased intracellular manganese, were thus not obtained. The failure to note a clinical response to antioxidant therapy may be due to factors dependent upon dosage of, or interaction between, the antioxidant compounds given, or on restricted bioavailability of the antioxidants at critical anatomical sites, and does not per se invalidate the model of acute porphyria as a hyperoxidative condition.
Adult↗
Immunological determination of porphobilinogen deaminase as a diagnostic measure in acute intermittent porphyria.
Manifest disease symptoms of acute intermittent porphyria may be provoked by several external factors. Latent gene carriers should be identified at an early stage and informed about preventive measures. Porphobilinogen deaminase activity in red blood cells may be used as one indicator of the carrier state. However, there is an overlap of enzyme activity between healthy controls and carriers of the trait. Thus latent gene carriers cannot always be identified. In the present study a recently reported enzyme-linked immunosorbent assay (ELISA) was used to quantify the concentration of the enzyme porphobilinogen deaminase in erythrocytes in 845 individuals belonging to families with acute intermittent porphyria. Using previous available diagnostic methods 417 of them had been diagnosed as gene carriers, 339 as non-carriers, and 89 were of "uncertain" classification. Of those with "uncertain" diagnosis, 19 had a decreased concentration of porphobilinogen deaminase and could thus be diagnosed as gene carriers. However, 70 cases of the 89 were still "uncertain", which underlines the need for further improvement of the diagnostic methods.
Ammonia-Lyases↗
[Acute intermittent porphyria at 4 months of age].
Acute intermittent porphyria was diagnosed in a child who presented with an acute abdomen and neurological signs of the age of four months. The diagnosis was confirmed by the absence of uroporphyrinogen synthetase in the erythrocytes. The rarity of the disorder at this age is emphasised.
Abdomen, Acute↗
Prevalence of acute intermittent porphyria in a Mexican psychiatric population.
BACKGROUND: Acute intermittent porphyria is a hereditary error of porphyrin metabolism in which the main metabolic defect is caused by a decrease in porphobilinogen deaminase activity. Previous work has demonstrated a higher prevalence of acute intermittent porphyria in the psychiatric patient population than in the general population. The goal of this study was evaluate 300 psychiatric patients and 150 control subjects to detect acute intermittent porphyria by measurement of porphobilinogen (PBG) deaminase activity in blood. METHODS: Screening for porphobilinogen deaminase activity was carried out by fluorometric measurement of porphyrins synthesized during 1 h in blood and the measurement of delta-aminolevulinic acid and porphobilinogen in urine. RESULTS: We found two psychiatric patients, one male and one female, with decreased porphobilinogen deaminase activity. When the families of these patients were studied, one brother was found to have an abnormality. Among controls, a woman was found to have the abnormality and her father was found to have typical features of the disease. CONCLUSIONS: These results indicate a prevalence of porphyria in Mexican psychiatric patients similar to controls, and that measurement of PBG deaminase activity is a good tool for defining acute intermittent porphyria carriers.
Acute Disease↗
Acute intermittent porphyria and mental illness--a family study.
All cases of acute intermittent porphyria (AIP) are believed to be caused by a mutation in the gene encoding for porphobilinogen deaminase, a rate-limiting enzyme in the haem synthetic pathway. This gene has been mapped to the long arm of chromosome 11, a region of the genome that has recently attracted considerable attention as a possible location for genes implicated in major mental disorder. This study was designed to show whether major mental illness co-segregated with acute intermittent porphyria in families where the two conditions are found. The study also investigated the relation between clinical mental symptoms and biochemical parameters of acute intermittent porphyria. The case records of 344 consecutive patients admitted to the Porphyrias Research Group in the Western Infirmary in Glasgow between 1950 and 1988 with acute intermittent porphyria were examined for evidence of psychiatric contact. Of 16 individuals identified, 12 were available for the study. Forty relatives of these 12 probands, including 9 who were asymptomatic carriers of AIP, were interviewed for lifetime history of mental illness and current symptoms. Comparisons were made between 4 groups of patients based on urinary porphyrin levels and erythrocyte enzyme activity; 1) manifest acute intermittent porphyria, 2) latent acute intermittent porphyria, 3) normal relatives and 4) total acute intermittent porphyria (latent and manifest combined). No association was found between AIP and schizophrenia or manic-depressive illness. Only one patient with schizophrenia was found in the sample of 344 case notes, and in 2 families bipolar illness was found but did not segregate with acute intermittent porphyria. The commonest psychiatric diagnosis in patients was generalized anxiety.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
Acute intermittent porphyria presenting as a diffuse encephalopathy.
Although acute intermittent porphyria presents with dramatic neurological findings, the diagnosis is difficult. An 18-year-old woman had a clinical picture of porphyric encephalopathy. Magnetic resonance (MR) imaging demonstrated multiple large contrast-enhancing subcortical white matter lesions, which regressed with glucose and hematin infusions. Diffusion-weighted MR imaging was normal, and MR spectroscopy excluded acute demyelination or tissue necrosis. MR findings of acute intermittent porphyria can differ from those in posterior reversible encephalopathy syndrome by virtue of intense contrast enhancement. Because diffusion-weighted MR imaging and spectroscopy were normal, the lesions are likely caused by reversible vasogenic edema and transient breakdown of the blood-brain barrier.
Adolescent↗