1. Adult-onset diagnosis of urea cycle disorders: Results of a French cohort of 71 patients
- Author
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Christian Lavigne, Lena Damaj, Esther Noel, François Maillot, Sybill Charriere, Adrien Bigot, Vincent Rigalleau, Claire Douillard, Fanny Mochel, Elsa Kaphan, Ségolène Toquet, Amélie Servettaz, Samir Mesli, Gérard Besson, Roselyne Garnotel, Caroline Moreau, Agathe Roubertie, Sylvie Odent, Isabelle Redonnet-Vernhet, Jean Baptiste Arnoux, Marta Spodenkiewicz, Aude Servais, Laboratoire Maladies Rares: Génétique et Métabolisme (Bordeaux) (U1211 INSERM/MRGM), Université de Bordeaux (UB)-Groupe hospitalier Pellegrin-Institut National de la Santé et de la Recherche Médicale (INSERM), Bordeaux population health (BPH), and Université de Bordeaux (UB)-Institut de Santé Publique, d'Épidémiologie et de Développement (ISPED)-Institut National de la Santé et de la Recherche Médicale (INSERM)
- Subjects
Adult ,Male ,Ornithine ,Pediatrics ,medicine.medical_specialty ,Adolescent ,Argininosuccinic Aciduria ,Context (language use) ,Inherited metabolic diseases ,Urea cycle disorders ,03 medical and health sciences ,Young Adult ,Sex Factors ,Intensive care ,Genetics ,Medicine ,Adults ,Humans ,Hyperammonemia ,Decompensation ,Family history ,Age of Onset ,Urea Cycle Disorders, Inborn ,Genetics (clinical) ,030304 developmental biology ,Aged ,Retrospective Studies ,Coma ,Aged, 80 and over ,0303 health sciences ,biology ,business.industry ,030305 genetics & heredity ,Middle Aged ,medicine.disease ,3. Good health ,Ornithine Carbamoyltransferase Deficiency Disease ,Citrin ,Argininosuccinic aciduria ,Late-onset diagnosis ,Cohort ,biology.protein ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,Female ,France ,medicine.symptom ,business - Abstract
BACKGROUND: Urea cycle disorders (UCD) are rare diseases that usually affect neonates or young children. During decompensations, hyperammonemia is neurotoxic, leading to severe symptoms and even coma and death if not treated rapidly. AIMS: Description of a cohort of patients with adult onset of UCDs. METHODS: Multicentric, retrospective and descriptive study of French adult patients with a diagnosis after 16 years of age of UCDs due to a deficiency in one of the 6 enzymes (arginase, ASL, ASS, CPS1, NAGS, OTC) or the two transporters (ORNT1 or citrin). RESULTS: Seventy-one patients were included (68% female, 32% male). The diagnosis was made in the context of (i) a metabolic decompensation (42%), (ii) family history (55%), or (iii) chronic symptoms (3%). The median age at diagnosis was 33 years (range 16-86). Eighty-nine percent of patients were diagnosed with OTC deficiency, 7% CPS1 deficiency, 3% HHH syndrome and 1% argininosuccinic aciduria. For those diagnosed during decompensations (including 23 OTC cases, mostly female), 89% required an admission in intensive care units. Seven deaths were attributed to UCD - 6 decompensations and 1 epilepsy secondary to inaugural decompensation. CONCLUSION: This is the largest cohort of UCDs diagnosed in adulthood, which confirms the triad of neurological, gastrointestinal and psychiatric symptoms during hyperammonemic decompensations. We stress that females with OTC deficiency can be symptomatic. With 10% of deaths in this cohort, UCDs in adults remain a life-threatening condition. Physicians working in adult care must be aware of late-onset presentations given the implications for patients and their families. This article is protected by copyright. All rights reserved.
- Published
- 2021
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