title: Aromatic L-amino acid decarboxylase deficiency: clinical features, diagnosis, and treatment of a second family.
abstract: Aromatic L-amino acid decarboxylase deficiency is an inborn error of metabolism that leads to combined serotonin and catecholamine deficiency, first described by Hyland et al in 1990. The clinical features, biochemical findings, and treatment of the second family with this condition are reported. Our male patient presented with developmental delay, extreme hypotonia, oculogyric crises, and irritability. The diagnosis of this inborn error of biogenic amine metabolism was accomplished by determining low concentrations of homovanillic, 5-hydroxyindoleacetic acid, and 3-methoxy-4-hydroxyphenyl-ethyleneglycol in cerebrospinal fluid with normal biopterin metabolism and increased L-dopa, in plasma, cerebrospinal fluid, and urine. Greatly reduced activity of aromatic L-amino acid decarboxylase in plasma confirmed this diagnosis. Combined treatment with pyridoxine, tranylcypromine, and bromocriptine produced some clinical improvement.
authors.affiliation: University of Texas Health Science Center, Medical School-Houston, USA.
authors.forename: A
authors.initials: A
authors.lastname: Maller
authors.forename: K
authors.initials: K
authors.lastname: Hyland
authors.forename: S
authors.initials: S
authors.lastname: Milstien
authors.forename: I
authors.initials: I
authors.lastname: Biaggioni
authors.forename: I J
authors.initials: IJ
authors.lastname: Butler
mesh_terms: D006916:5-Hydroxytryptophan / Q000032:analysis; D000598:Amino Acids, Cyclic / Q000378:metabolism*; D001142:Aromatic-L-Amino-Acid Decarboxylases / Q000172:deficiency*; D015306:Biogenic Monoamines / Q000378:metabolism*; D002675:Child, Preschool; D003241:Consanguinity; D002658:Developmental Disabilities / Q000201:enzymology; D006719:Homovanillic Acid / Q000134:cerebrospinal fluid; D006801:Humans; D006897:Hydroxyindoleacetic Acid / Q000134:cerebrospinal fluid; D007492:Iran / Q000208:ethnology; D007980:Levodopa / Q000032:analysis; D008137:Longitudinal Studies; D008297:Male; D008734:Methoxyhydroxyphenylglycol / Q000134:cerebrospinal fluid; D009123:Muscle Hypotonia / Q000201:enzymology; D011736:Pyridoxine / Q000627:therapeutic use
chemical_list: D000598:Amino Acids, Cyclic; D015306:Biogenic Monoamines; D007980:Levodopa; D008734:Methoxyhydroxyphenylglycol; D006897:Hydroxyindoleacetic Acid; D006916:5-Hydroxytryptophan; D001142:Aromatic-L-Amino-Acid Decarboxylases; D011736:Pyridoxine; D006719:Homovanillic Acid