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Hyperornithinemia

MedGen UID:
109343
Concept ID:
C0599035
Disease or Syndrome
Synonym: Ornithinemia
SNOMED CT: Deficiency of ornithine-oxo-acid aminotransferase (276426004); Ornithine oxo-acid aminotransferase deficiency (276426004); Ornithine aminotransferase deficiency (276426004); Ornithine ketoacid transaminase deficiency (276426004); OKT deficiency (276426004); Ornithine-oxo-acid amino acid transferase deficiency (276426004); Ornithine-delta-aminotransferase deficiency (276426004); OAT - Ornithine oxo-acid aminotransferase deficiency (276426004); OAT deficiency (276426004); Hyperornithinemia (33985005)
 
HPO: HP:0012026
OMIM®: 258870

Definition

Gyrate atrophy of the choroid and retina, which is often shortened to gyrate atrophy, is an inherited disorder characterized by progressive vision loss. People with this disorder have an ongoing loss of cells (atrophy) in the retina, which is the specialized light-sensitive tissue that lines the back of the eye, and in a nearby tissue layer called the choroid. During childhood, they begin experiencing nearsightedness (myopia), difficulty seeing in low light (night blindness), and loss of side (peripheral) vision. Over time, their field of vision continues to narrow, resulting in tunnel vision. Many people with gyrate atrophy also develop clouding of the lens of the eyes (cataracts). These progressive vision changes lead to blindness by about the age of 50.

Most people with gyrate atrophy have no symptoms other than vision loss, but some have additional features of the disorder. Occasionally, newborns with gyrate atrophy develop excess ammonia in the blood (hyperammonemia), which may lead to poor feeding, vomiting, seizures, or coma. Neonatal hyperammonemia associated with gyrate atrophy generally responds quickly to treatment and does not recur after the newborn period.

Gyrate atrophy usually does not affect intelligence; however, abnormalities may be observed in brain imaging or other neurological testing. In some cases, mild to moderate intellectual disability is associated with gyrate atrophy.

Gyrate atrophy may also cause disturbances in the nerves connecting the brain and spinal cord to muscles and sensory cells (peripheral nervous system). In some people with the disorder these abnormalities lead to numbness, tingling, or pain in the hands or feet, while in others they are detectable only by electrical testing of the nerve impulses.

In some people with gyrate atrophy, a particular type of muscle fibers (type II fibers) break down over time. While this muscle abnormality usually causes no symptoms, it may result in mild weakness. [from MedlinePlus Genetics]

Conditions with this feature

Ornithine aminotransferase deficiency
MedGen UID:
6695
Concept ID:
C0018425
Disease or Syndrome
Gyrate atrophy of the choroid and retina (GACR) due to deficiency of ornithine aminotransferase is clinically characterized by a triad of progressive chorioretinal degeneration, early cataract formation, and type II muscle fiber atrophy. Characteristic chorioretinal atrophy with progressive constriction of the visual fields leads to blindness at the latest during the sixth decade of life. Patients generally have normal intelligence (summary by Peltola et al., 2002). See 238970 for another hyperornithinemia syndrome.
Hyperornithinemia-hyperammonemia-homocitrullinuria syndrome
MedGen UID:
82815
Concept ID:
C0268540
Disease or Syndrome
Hyperornithinemia-hyperammonemia-homocitrullinuria (HHH) syndrome is a disorder of the urea cycle and ornithine degradation pathway. Clinical manifestations and age of onset vary among individuals even in the same family. Neonatal onset (~8% of affected individuals). Manifestations of hyperammonemia usually begin 24-48 hours after feeding begins and can include lethargy, somnolence, refusal to feed, vomiting, tachypnea with respiratory alkalosis, and/or seizures. Infantile, childhood, and adult onset (~92%). Affected individuals may present with: Chronic neurocognitive deficits (including developmental delay, ataxia, spasticity, learning disabilities, cognitive deficits, and/or unexplained seizures); Acute encephalopathy secondary to hyperammonemic crisis precipitated by a variety of factors; and Chronic liver dysfunction (unexplained elevation of liver transaminases with or without mild coagulopathy, with or without mild hyperammonemia and protein intolerance). Neurologic findings and cognitive abilities can continue to deteriorate despite early metabolic control that prevents hyperammonemia.

Professional guidelines

PubMed

Häberle J, Burlina A, Chakrapani A, Dixon M, Karall D, Lindner M, Mandel H, Martinelli D, Pintos-Morell G, Santer R, Skouma A, Servais A, Tal G, Rubio V, Huemer M, Dionisi-Vici C
J Inherit Metab Dis 2019 Nov;42(6):1192-1230. Epub 2019 May 15 doi: 10.1002/jimd.12100. PMID: 30982989
Wasim M, Awan FR, Khan HN, Tawab A, Iqbal M, Ayesha H
Biochem Genet 2018 Apr;56(1-2):7-21. Epub 2017 Nov 1 doi: 10.1007/s10528-017-9825-6. PMID: 29094226
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Recent clinical studies

Etiology

Magliyah M, Alsalamah AK, AlOtaibi M, Nowilaty SR
Ophthalmic Genet 2021 Apr;42(2):204-208. Epub 2020 Nov 26 doi: 10.1080/13816810.2020.1843185. PMID: 33243052
Wasim M, Awan FR, Khan HN, Tawab A, Iqbal M, Ayesha H
Biochem Genet 2018 Apr;56(1-2):7-21. Epub 2017 Nov 1 doi: 10.1007/s10528-017-9825-6. PMID: 29094226
Kim SZ, Song WJ, Nyhan WL, Ficicioglu C, Mandell R, Shih VE
Clin Chim Acta 2012 Jul 11;413(13-14):1151-5. Epub 2012 Mar 23 doi: 10.1016/j.cca.2012.03.015. PMID: 22465082
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Vannas-Sulonen K, Simell O, Sipilä I
Ophthalmology 1987 Nov;94(11):1428-33. PMID: 3684217

Diagnosis

Martinelli D, Fiermonte G, Häberle J, Boenzi S, Goffredo BM, Travaglini L, Agolini E, Porcelli V, Dionisi-Vici C
Eur J Hum Genet 2020 Jul;28(7):982-987. Epub 2020 Apr 2 doi: 10.1038/s41431-020-0616-x. PMID: 32242103Free PMC Article
Häberle J, Burlina A, Chakrapani A, Dixon M, Karall D, Lindner M, Mandel H, Martinelli D, Pintos-Morell G, Santer R, Skouma A, Servais A, Tal G, Rubio V, Huemer M, Dionisi-Vici C
J Inherit Metab Dis 2019 Nov;42(6):1192-1230. Epub 2019 May 15 doi: 10.1002/jimd.12100. PMID: 30982989
Tal G, Dar DE, Idin A, Korman SH, Dumin E
Clin Chem 2018 Jun;64(6):978-980. doi: 10.1373/clinchem.2018.286617. PMID: 29844061
Wasim M, Awan FR, Khan HN, Tawab A, Iqbal M, Ayesha H
Biochem Genet 2018 Apr;56(1-2):7-21. Epub 2017 Nov 1 doi: 10.1007/s10528-017-9825-6. PMID: 29094226
Martinelli D, Diodato D, Ponzi E, Monné M, Boenzi S, Bertini E, Fiermonte G, Dionisi-Vici C
Orphanet J Rare Dis 2015 Mar 11;10:29. doi: 10.1186/s13023-015-0242-9. PMID: 25874378Free PMC Article

Therapy

Ono H, Tamada T, Shigematsu Y
Pediatr Int 2018 Aug;60(8):762-764. Epub 2018 Jul 30 doi: 10.1111/ped.13608. PMID: 30058227
Sipilä I, Rapola J, Simell O, Vannas A
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Berson EL, Schmidt SY, Shih VE
Ophthalmology 1978 Oct;85(10):1018-27. doi: 10.1016/s0161-6420(78)35588-3. PMID: 740364

Prognosis

Magliyah M, Alsalamah AK, AlOtaibi M, Nowilaty SR
Ophthalmic Genet 2021 Apr;42(2):204-208. Epub 2020 Nov 26 doi: 10.1080/13816810.2020.1843185. PMID: 33243052
Martinelli D, Diodato D, Ponzi E, Monné M, Boenzi S, Bertini E, Fiermonte G, Dionisi-Vici C
Orphanet J Rare Dis 2015 Mar 11;10:29. doi: 10.1186/s13023-015-0242-9. PMID: 25874378Free PMC Article
Kim SZ, Song WJ, Nyhan WL, Ficicioglu C, Mandell R, Shih VE
Clin Chim Acta 2012 Jul 11;413(13-14):1151-5. Epub 2012 Mar 23 doi: 10.1016/j.cca.2012.03.015. PMID: 22465082
Vannas-Sulonen K, Simell O, Sipilä I
Ophthalmology 1987 Nov;94(11):1428-33. PMID: 3684217
Berson EL, Schmidt SY, Shih VE
Ophthalmology 1978 Oct;85(10):1018-27. doi: 10.1016/s0161-6420(78)35588-3. PMID: 740364

Clinical prediction guides

Nguyen KN, Tran VK, Nguyen NL, Can TBN, Dang TKG, Nguyen TH, Do TTM, Phuong LT, Tran TH, Ta TV, Tu NH, Vu CD
Medicina (Kaunas) 2024 Nov 16;60(11) doi: 10.3390/medicina60111877. PMID: 39597062Free PMC Article
Silvera-Ruiz SM, Gemperle C, Peano N, Olivero V, Becerra A, Häberle J, Gruppi A, Larovere LE, Motrich RD
Front Immunol 2022;13:861516. Epub 2022 May 27 doi: 10.3389/fimmu.2022.861516. PMID: 35711415Free PMC Article
Chen J, Bennett MJ
Methods Mol Biol 2010;603:445-51. doi: 10.1007/978-1-60761-459-3_43. PMID: 20077096
Haust MD
Pathol Res Pract 1995 Oct;191(10):1062-5. doi: 10.1016/s0344-0338(11)80613-8. PMID: 8838382
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Recent systematic reviews

Martinelli D, Diodato D, Ponzi E, Monné M, Boenzi S, Bertini E, Fiermonte G, Dionisi-Vici C
Orphanet J Rare Dis 2015 Mar 11;10:29. doi: 10.1186/s13023-015-0242-9. PMID: 25874378Free PMC Article

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