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Adult phenylketonuria
1Phenylketonuria Programme, Division of Clinical and Biochemical Genetics, Department of Pediatrics and the Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada. whanley@sickkids.ca
Insights
Phenylketonuria (PKU) newborn screening enables intellectual development through early diet intervention. However, adults with PKU require specialized lifelong care and support, highlighting a critical need for dedicated adult physicians.
Area of Science:
- Metabolic disorders
- Genetics
- Public health
Background:
- Newborn screening for phenylketonuria (PKU) has been standard for decades.
- Early dietary intervention (phenylalanine-restricted diets) has led to improved intellectual outcomes in adults with PKU.
- Significant numbers of PKU patients reach adulthood annually.
Purpose of the Study:
- To review the long-term outcomes and ongoing needs of adults with phenylketonuria.
- To highlight the challenges in adult care for PKU patients.
- To emphasize the need for specialized medical professionals for adult PKU management.
Main Methods:
- Review of existing literature and clinical recommendations regarding phenylketonuria management.
- Analysis of outcomes in adult patients with phenylketonuria.
- Identification of gaps in adult care provision.
Main Results:
- Adults with PKU, particularly those with milder forms, may not require strict dietary control post-adolescence for intellectual stability.
- Neuropsychological and psychosocial issues are prevalent in adult PKU patients.
- There is a notable scarcity of adult physicians specializing in PKU care.
Conclusions:
- Lifelong monitoring and support are crucial for adults with phenylketonuria, even if intellectual function is preserved.
- Addressing neuropsychological and psychosocial challenges requires dedicated healthcare provider involvement.
- There is an urgent requirement for physicians to lead and coordinate comprehensive adult PKU care.
Abstract:
Newborn screening for phenylketonuria began 35 to 40 years ago in most industrialized countries. Because of this initiative, which resulted in early institution of phenylalanine-restricted diets, there are now many young adults with this disease who have normal or near-normal intellectual function. In North America alone, 200 patients with phenylketonuria enter adulthood every year. Most expert panels recommend following a phenylalanine-restricted "diet for life." However, there are few adult physicians dedicated to continuing care of this group, with the possible exception of maternal phenylketonuria. Up to 10% of adults with classic phenylketonuria, and possibly 50% of those with milder variants, may not need treatment; after adolescence, intelligence does not appear to deteriorate, at least into early adulthood, even if diet therapy is discontinued or not in good control. However, neuropsychological and psychosocial problems develop frequently, needing focused and intensive support by health care providers. New investigative methods and treatment options are on the horizon. There is an urgent need for physicians who will orchestrate the care of adults with phenylketonuria.
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