1
|
Shiraishi W, Tateishi T, Hayashida S, Tajima G, Tsumura M, Isobe N. [A case of very long chain acyl-CoA dehydrogenase deficiency diagnosed due to a trigger of hyperemesis gravidarum during pregnancy]. Rinsho Shinkeigaku 2023; 63:656-660. [PMID: 37779023 DOI: 10.5692/clinicalneurol.cn-001854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
A 25-year-old Japanese woman with a history of repeated episodes of rhabdomyolysis since the age of 12 presented with rhabdomyolysis caused by hyperemesis gravidarum. Blood tests showed an elevated serum CK level (11,755 IU/l; normal: 30-180 IU/l). Carnitine fractionation analysis revealed low levels of total carnitine (18.3 μmol/l; normal: 45-91 μmol/l), free carnitine (13.1 μmol/l; normal: 36-74 μmol/l), and acylcarnitine (5.2 μmol/l; normal: 6-23 μmol/l). Tandem mass spectrometry showed high levels of C14:1 acylcarnitine (0.84 nmol/ml: normal: <0.4 nmol/ml) and a high C14:1/C2 ratio of 0.253 (normal: <0.013), indicating a potential diagnosis of very long-chain acyl-CoA dehydrogenase (VLCAD) deficiency. Enzyme activity measurement in the patient's peripheral blood lymphocytes confirmed the diagnosis of VLCAD deficiency, with low palmitoyl-CoA dehydrogenase levels (6.5% of normal control value). With the patient's informed consent, acyl-CoA dehydrogenase very long-chain (ACADVL) gene analysis revealed compound heterozygous mutations of c.1332G>A in exon 13 and c.1349G>A (p.R450H) in exon 14. In Japan, neonatal mass screening is performed to detect congenital metabolic diseases. With the introduction of tandem mass screening in 2014, fatty acid metabolism disorders, including VLCAD deficiency, are being detected before the onset of symptoms. However, it is important to note that mass screening cannot detect all cases of this disease. For patients with recurrent rhabdomyolysis, it is essential to consider congenital diseases, including fatty acid metabolism disorders, as a potential diagnosis.
Collapse
Affiliation(s)
- Wataru Shiraishi
- Department of Neurology, Kokura Memorial Hospital
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University
| | - Takahisa Tateishi
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University
- Division of Respirology, Neurology and Rheumatology, Department of Medicine, Kurume University School of Medicine
| | - Shotaro Hayashida
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University
| | - Go Tajima
- Division of Neonatal Screening, Research Institute, National Center for Child Health and Development
- Department of Pediatrics, Hiroshima University Graduate School of Biomedical & Health Sciences
| | - Miyuki Tsumura
- Division of Neonatal Screening, Research Institute, National Center for Child Health and Development
| | - Noriko Isobe
- Department of Neurology, Neurological Institute, Graduate School of Medical Sciences, Kyushu University
| |
Collapse
|
2
|
Akar HT, Çağan M, Yıldız Y, Sivri HS. Complicated peripartum course in a patient with very long-chain acyl-coenzyme A dehydrogenase (VLCAD) deficiency. Neuromuscul Disord 2021; 31:566-569. [PMID: 33965301 DOI: 10.1016/j.nmd.2021.03.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/22/2021] [Accepted: 03/31/2021] [Indexed: 11/28/2022]
Abstract
Very long-chain acyl-coenzyme A (CoA) dehydrogenase (VLCAD) deficiency is an autosomal recessive fatty acid oxidation disorder characterized by rhabdomyolysis, hypoglycemia and cardiomyopathy. The general treatment approach in adult patients is based on the prevention of catabolism. High carbohydrate, low fat diet and supplementation of medium-chain triglycerides are essential in the treatment. There is little experience with pregnancy follow-up in this patient group. We present a complicated peripartum course and successful management in a patient with VLCAD deficiency. Although high-dose glucose infusion was initiated, creatine kinase levels significantly increased in the immediate postpartum period, but the patient remained asymptomatic and rhabdomyolysis resolved rapidly after increasing the glucose infusion rate.
Collapse
Affiliation(s)
- Halil Tuna Akar
- Department of Pediatrics, Pediatric Metabolism and Nutrition Unit, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - Murat Çağan
- Department of Obstetrics and Gynecology, Perinatology Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Yılmaz Yıldız
- Department of Pediatrics, Pediatric Metabolism and Nutrition Unit, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey
| | - H Serap Sivri
- Department of Pediatrics, Pediatric Metabolism and Nutrition Unit, Hacettepe University Faculty of Medicine, Ankara 06230, Turkey.
| |
Collapse
|
3
|
Zagorda B, Camdessanché JP, Féasson L. Pregnancy and myopathies: Reciprocal impacts between pregnancy, delivery, and myopathies and their treatments. A clinical review. Rev Neurol (Paris) 2021; 177:225-234. [PMID: 33648783 DOI: 10.1016/j.neurol.2020.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 09/07/2020] [Accepted: 09/30/2020] [Indexed: 11/16/2022]
Abstract
During pregnancy, women undergo physical and physiological changes, which can impact the neuromuscular disease course, but also delivery and fetus health. Generally, there is little impact on the disease course, but sometimes an impairment is noticed, which could be attributed to pregnancy and not to disease progression. Cardiac and respiratory functions have to be assessed at the beginning of pregnancy and a close follow-up is mandatory in case of disorder. Labour and delivery are often impacted. Labour is prolonged because of muscle weakness that is an increased risk of instrumental delivery or Cesarean sections. Patients with myotonic dystrophy are at risk of postpartum hemorrhage. Fetal loss can be associated with fetal disease in myotonic dystrophy, and is at high risk for patients with active inflammatory myopathy only.
Collapse
Affiliation(s)
- B Zagorda
- Service de médecine physique et de réadaptation, Hôpital Bellevue, CHU de Saint-Étienne, Saint-Étienne, France; Centre référent maladies neuromusculaires rares, CHU de St Étienne, Euro-NmD, Saint-Étienne, France
| | - J-P Camdessanché
- Service de neurologie, Hôpital Nord, CHU de Saint-Étienne, Saint-Étienne, France; Centre référent maladies neuromusculaires rares, CHU de St Étienne, Euro-NmD, Saint-Étienne, France
| | - L Féasson
- Unité de myologie, service de physiologie clinique et de l'exercice, Hôpital Nord, CHU de Saint-Étienne, Saint-Étienne, France; Centre référent maladies neuromusculaires rares, CHU de St Étienne, Euro-NmD, Saint-Étienne, France.
| |
Collapse
|
4
|
Van Calcar SC, Sowa M, Rohr F, Beazer J, Setlock T, Weihe TU, Pendyal S, Wallace LS, Hansen JG, Stembridge A, Splett P, Singh RH. Nutrition management guideline for very-long chain acyl-CoA dehydrogenase deficiency (VLCAD): An evidence- and consensus-based approach. Mol Genet Metab 2020; 131:23-37. [PMID: 33093005 DOI: 10.1016/j.ymgme.2020.10.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 08/31/2020] [Accepted: 10/02/2020] [Indexed: 12/18/2022]
Abstract
The nutrition management guideline for very-long chain acyl-CoA dehydrogenase deficiency (VLCAD) is the fourth in a series of web-based guidelines focusing on the diet treatment for inherited metabolic disorders and follows previous publication of guidelines for maple syrup urine disease (2014), phenylketonuria (2016) and propionic acidemia (2019). The purpose of this guideline is to establish harmonization in the treatment and monitoring of individuals with VLCAD of all ages in order to improve clinical outcomes. Six research questions were identified to support guideline development on: nutrition recommendations for the healthy individual, illness management, supplementation, monitoring, physical activity and management during pregnancy. This report describes the methodology used in its development including review, critical appraisal and abstraction of peer-reviewed studies and unpublished practice literature; expert input through two Delphi surveys and a nominal group process; and external review from metabolic physicians and dietitians. It includes the summary statements of the nutrition management recommendations for each research question, followed by a standardized rating based on the strength of the evidence. Online, open access of the full published guideline allows utilization by health care providers, researchers and collaborators who advise, advocate and care for individuals with VLCAD and their families and can be accessed from the Genetic Metabolic Dietitians International (https://GMDI.org) and Southeast Regional Genetics Network (https://southeastgenetics.org/ngp) websites.
Collapse
Affiliation(s)
| | - M Sowa
- CHOC Children's, Orange, CA, USA
| | - F Rohr
- Met Ed Co, Boulder, CO, USA; Children's Hospital of Boston, Boston, MA, USA
| | - J Beazer
- National PKU News, How Much Phe, LLC, Helena, MT, USA
| | - T Setlock
- Shodair Children's Hospital, Helena, MT, USA
| | - T U Weihe
- Children's Mercy, Kansas City, MO, USA
| | - S Pendyal
- Duke University Health System, Durham, NC, USA
| | - L S Wallace
- University of Tennessee Health Science Center, Memphis, TN, USA
| | - J G Hansen
- Oregon Health & Science University, Portland, OR, USA
| | | | - P Splett
- University of Minnesota, St. Paul, MN, USA
| | | |
Collapse
|
5
|
Stone J, Reed D. Maternal genetic diseases: potential concerns for mother and baby. Hum Genet 2019; 139:1173-1182. [PMID: 31729547 DOI: 10.1007/s00439-019-02086-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 10/29/2019] [Indexed: 12/14/2022]
Abstract
With advances in medical care, many women with genetic conditions previously known to decrease life expectancy are reaching childbearing age. Thus, it is important to understand the management of patients in the preconception, antepartum, and postpartum periods as they pose a unique challenge to the obstetrician. Most rare disorders lack well-established clinical guidelines for management in pregnancy. Existing data stem from case reports, case series, and expert opinion. We aim to summarize these recommendations and develop a clinical reference for managing reproductive age women with these conditions. We review recommendations for women with inborn errors in metabolism, connective tissue disorders, skeletal dysplasia, and selected single gene disorders. In all cases, it is crucial to employ a multidisciplinary team to optimize care for patients with rare disease before, during, and immediately after their pregnancies. The emphasis on expert consensus recommendations in the guidance of obstetric care is a signal that more studies are needed to determine best practices.
Collapse
Affiliation(s)
- Julie Stone
- Tufts Medical Center, 800 Washington Center, Boston, MA, 02111, USA
| | - Dallas Reed
- Tufts Medical Center, 800 Washington Center, Boston, MA, 02111, USA.
| |
Collapse
|
6
|
Yamada K, Matsubara K, Matsubara Y, Watanabe A, Kawakami S, Ochi F, Kuwabara K, Mushimoto Y, Kobayashi H, Hasegawa Y, Fukuda S, Yamaguchi S, Taketani T. Clinical course in a patient with myopathic VLCAD deficiency during pregnancy with an affected baby. JIMD Rep 2019; 49:17-20. [PMID: 31497477 PMCID: PMC6718132 DOI: 10.1002/jmd2.12061] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 05/29/2019] [Accepted: 05/31/2019] [Indexed: 11/08/2022] Open
Abstract
Very long-chain acyl-CoA dehydrogenase (VLCAD) deficiency is an autosomal recessive mitochondrial fatty acid oxidation disorder that manifests in three clinical forms: (a) severe, (b) milder, and (c) myopathic. Patients with the myopathic form present intermittent muscular symptoms such as myalgia, muscle weakness, and rhabdomyolysis during adolescence or adulthood. Here, the clinical symptoms and serum creatine kinase (CK) levels of a pregnant 31-year-old woman with the myopathic form of VLCAD deficiency were reduced during pregnancy. Clinical symptoms rarely appeared during pregnancy, although she had sometimes suffered from muscular symptoms before pregnancy. When ritodrine was administered for threatened premature labor at 35 weeks of gestation, her CK level was elevated to over 3900 IU/L. She delivered a full-term baby via cesarean section but suffered from muscle weakness with elevated CK levels soon after delivery. It has been reported that an unaffected placenta and fetus can improve maternal β-oxidation during pregnancy. However, in our case, the baby was also affected by VLCAD deficiency. These suggest that the clinical symptoms of a woman with VLCAD deficiency might be reduced during pregnancy even if the fetus is affected with VLCAD deficiency.
Collapse
Affiliation(s)
- Kenji Yamada
- Department of PediatricsShimane University Faculty of MedicineIzumoShimaneJapan
| | - Keiichi Matsubara
- Department of Obstetrics and GynecologyEhime University School of MedicineToonEhimeJapan
| | - Yuko Matsubara
- Department of Obstetrics and GynecologyEhime University School of MedicineToonEhimeJapan
| | - Asami Watanabe
- Department of PediatricsYawatahama City General HospitalYawatahamaEhimeJapan
- Department of PediatricsEhime University Graduate School of MedicineToonEhimeJapan
| | - Sanae Kawakami
- Department of PediatricsYawatahama City General HospitalYawatahamaEhimeJapan
| | - Fumihiro Ochi
- Department of PediatricsYawatahama City General HospitalYawatahamaEhimeJapan
- Department of PediatricsEhime University Graduate School of MedicineToonEhimeJapan
| | - Kozue Kuwabara
- Department of PediatricsEhime University Graduate School of MedicineToonEhimeJapan
| | - Yuichi Mushimoto
- Department of Pediatrics, Graduate School of Medical SciencesKyushu UniversityHigashi‐kuFukuokaJapan
| | - Hironori Kobayashi
- Department of PediatricsShimane University Faculty of MedicineIzumoShimaneJapan
| | - Yuki Hasegawa
- Department of PediatricsShimane University Faculty of MedicineIzumoShimaneJapan
| | - Seiji Fukuda
- Department of PediatricsShimane University Faculty of MedicineIzumoShimaneJapan
| | - Seiji Yamaguchi
- Department of PediatricsShimane University Faculty of MedicineIzumoShimaneJapan
| | - Takeshi Taketani
- Department of PediatricsShimane University Faculty of MedicineIzumoShimaneJapan
| |
Collapse
|
7
|
van Eerd DCD, Brussé IA, Adriaens VFR, Mankowski RT, Praet SFE, Michels M, Langeveld M. Management of an LCHADD Patient During Pregnancy and High Intensity Exercise. JIMD Rep 2016; 32:95-100. [PMID: 27334895 DOI: 10.1007/8904_2016_561] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2015] [Revised: 03/14/2016] [Accepted: 03/21/2016] [Indexed: 12/12/2022] Open
Abstract
In this report we describe a female Long-Chain 3-Hydroxyacyl-CoA Dehydrogenase Deficiency (LCHADD) patient who suffered from severe exercise intolerance. At age 34, the patient became pregnant for the first time. After an uneventful first 32 weeks of pregnancy she developed sinus tachycardia (resting heart rate 120-134 bpm) and lactate and creatinine kinase levels increased (3.3 mmol/L and 264 U/L, respectively). Increasing MCT supplementation (dose and frequency of administration) lowered heart rate and improved biochemical parameters. At 34 weeks the heart rate rose again and it was decided to deliver the child by caesarean section. Postpartum both mother and child did well.Prior to pregnancy, she performed exercise tests with different doses of medium chain triglycerides (MCTs) to establish a safe and effective exercise program (baseline test, second test with 10 g MCTs and third test with 20 g of MCTs). In the MCT supplemented tests the maximal power output was 23% (second test) and 26% (third test) higher, while cardiac output at maximal power output was the same in all three tests (~15.8 L/min).In conclusion, this is the first report of pregnancy in an LCHADD patient, with favourable outcome for both mother and child. Moreover, in the same patient, MCT supplementation improved cardiac performance and metabolic parameters during high intensity exercise. Using impedance cardiography, we got a clear indication that this benefit was due to improved muscle energy generation at high intensity exercise, since at the same cardiac output a higher power output could be generated.
Collapse
Affiliation(s)
- D C D van Eerd
- Center for Lysosomal and Metabolic Disease, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands
| | - I A Brussé
- Department of Obstetrics and Gynaecology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - V F R Adriaens
- Department of Anaesthesiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - R T Mankowski
- Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - S F E Praet
- Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M Michels
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M Langeveld
- Center for Lysosomal and Metabolic Disease, Erasmus University Medical Center, 's Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
| |
Collapse
|