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<span>Refsum disease</span>
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<span class="page-url print-only">URL of this page: https://medlineplus.gov/genetics/condition/refsum-disease/</span>
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<h1>Refsum disease</h1>
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<div class="mp-exp exp-full" data-bookmark="description">
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<h2>Description</h2>
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<section><div class="mp-content"><p>Refsum disease is an inherited condition that causes vision loss, absence of <a class="image-modal" data-alt="Illustration of odorant molecules entering the nose and contacting olfactory receptor neurons in the nasal cavity; these neurons transmit signals to olfactory bulb neurons on the bottom of the brain." data-caption="" data-credit="ellepigrafica/Shutterstock.com" data-filepath="images/PX00017S_PRESENTATION.jpeg" data-imgtype="genetics" data-pix="PX00017S" data-sourceurl="" data-title="The olfactory system" href="https://medlineplus.gov/images/PX00017S_PRESENTATION.jpeg" id="PX00017S_1" title="Show image">the sense of smell<img alt="" aria-hidden="true" class="image-modal-icon" src="https://medlineplus.gov/css/img/icon_camera_small.png"/></a> (anosmia), and a variety of other signs and symptoms.</p><p>The vision loss associated with Refsum disease is caused by an eye disorder called <a data-pid="15529" href="https://medlineplus.gov/genetics/condition/retinitis-pigmentosa/">retinitis pigmentosa</a>. This disorder affects <a class="image-modal" data-alt="Layers of cells that make up the retina, including the choroid, pigment epithelium, and rods and cones." data-caption="" data-credit="Alila Medical Media/Shutterstock.com" data-filepath="images/PX0000Z4_PRESENTATION.jpeg" data-imgtype="genetics" data-pix="PX0000Z4" data-sourceurl="" data-title="Structure of the retina" href="https://medlineplus.gov/images/PX0000Z4_PRESENTATION.jpeg" id="PX0000Z4_3" title="Show image">the retina<img alt="" aria-hidden="true" class="image-modal-icon" src="https://medlineplus.gov/css/img/icon_camera_small.png"/></a>, the light-sensitive layer at the back of the eye. Vision loss occurs as the light-sensing cells of the retina gradually deteriorate. The first sign of retinitis pigmentosa is usually a loss of night vision, which often becomes apparent in childhood. Over a period of years, the disease disrupts side (peripheral) vision and may eventually lead to blindness.</p><p>Vision loss and anosmia are seen in almost everyone with Refsum disease, but other signs and symptoms vary. About one-third of affected individuals are born with bone abnormalities of the hands and feet. Features that appear later in life can include progressive muscle weakness and wasting; poor balance and coordination (ataxia); hearing loss; and dry, scaly skin (ichthyosis). Additionally, some people with Refsum disease develop an abnormal heart rhythm (arrhythmia) and related heart problems that can be life-threatening.</p></div>
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</section>
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<div class="mp-exp exp-full" data-bookmark="frequency">
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<h2>Frequency</h2>
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<section><div class="mp-content"><p>The prevalence of Refsum disease is unknown, although the condition is thought to be uncommon.</p></div>
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</section>
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</div>
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<div class="mp-exp exp-full" data-bookmark="causes">
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<h2>Causes</h2>
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<section><div class="mp-content"><p>More than 90 percent of all cases of Refsum disease result from mutations in the <i><a data-pid="18353" href="https://medlineplus.gov/genetics/gene/phyh/">PHYH</a></i> gene. The remaining cases are caused by mutations in a gene called <i><a data-pid="18355" href="https://medlineplus.gov/genetics/gene/pex7/">PEX7</a></i>.</p><p>The signs and symptoms of Refsum disease result from the abnormal buildup of a type of fatty acid called phytanic acid. This substance is obtained from the diet, particularly from beef and dairy products. It is normally broken down through a process called alpha-oxidation, which occurs in cell structures called <a class="image-modal" data-alt="Lyosomes are cell structures in the cytoplasm." data-caption="" data-credit="U.S. National Library of Medicine" data-filepath="images/PX000084_PRESENTATION.jpeg" data-imgtype="genetics" data-pix="PX000084" data-sourceurl="" data-title="Lysosomes and peroxisomes" href="https://medlineplus.gov/images/PX000084_PRESENTATION.jpeg" id="PX000084_3" title="Show image">peroxisomes<img alt="" aria-hidden="true" class="image-modal-icon" src="https://medlineplus.gov/css/img/icon_camera_small.png"/></a>. These sac-like compartments contain enzymes that process many different substances, such as fatty acids and certain toxic compounds.</p><p>Mutations in either the <i>PHYH</i> or <i>PEX7</i> gene disrupt the usual functions of peroxisomes, including the breakdown of phytanic acid. As a result, this substance builds up in the body's tissues. The accumulation of phytanic acid is toxic to cells, although it is unclear how an excess of this substance affects <a class="image-modal" data-alt="Layers of cells that make up the retina, including the choroid, pigment epithelium, and rods and cones." data-caption="" data-credit="Alila Medical Media/Shutterstock.com" data-filepath="images/PX0000Z4_PRESENTATION.jpeg" data-imgtype="genetics" data-pix="PX0000Z4" data-sourceurl="" data-title="Structure of the retina" href="https://medlineplus.gov/images/PX0000Z4_PRESENTATION.jpeg" id="PX0000Z4_4" title="Show image">vision<img alt="" aria-hidden="true" class="image-modal-icon" src="https://medlineplus.gov/css/img/icon_camera_small.png"/></a> and <a class="image-modal" data-alt="Illustration of odorant molecules entering the nose and contacting olfactory receptor neurons in the nasal cavity; these neurons transmit signals to olfactory bulb neurons on the bottom of the brain." data-caption="" data-credit="ellepigrafica/Shutterstock.com" data-filepath="images/PX00017S_PRESENTATION.jpeg" data-imgtype="genetics" data-pix="PX00017S" data-sourceurl="" data-title="The olfactory system" href="https://medlineplus.gov/images/PX00017S_PRESENTATION.jpeg" id="PX00017S_5" title="Show image">smell<img alt="" aria-hidden="true" class="image-modal-icon" src="https://medlineplus.gov/css/img/icon_camera_small.png"/></a> and causes the other specific features of Refsum disease.</p></div>
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</section>
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<section>
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<div class="related-genes mp-exp exp-full">
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<h3>Learn more about the genes associated with Refsum disease</h3>
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<ul class="relatedmp">
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<li><a href="https://medlineplus.gov/genetics/gene/pex7/">PEX7</a></li>
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<li><a href="https://medlineplus.gov/genetics/gene/phyh/">PHYH</a></li>
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</ul>
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</div>
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</section>
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</div>
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<div class="mp-exp exp-full" data-bookmark="inheritance">
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<h2>Inheritance</h2>
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<section><div class="mp- mp-content"><p>This condition is inherited in an <a class="image-modal" data-alt="Both parents carry one copy of a mutated gene. In the next generation, one child is affected with the condition, two children are carriers, and one is unaffected and not a carrier." data-caption="" data-credit="U.S. National Library of Medicine" data-filepath="images/PX0000A4_PRESENTATION.jpeg" data-imgtype="genetics" data-pix="PX0000A4" data-sourceurl="" data-title="Autosomal recessive inheritance" href="https://medlineplus.gov/images/PX0000A4_PRESENTATION.jpeg" id="PX0000A4_1" title="Show image">autosomal recessive pattern<img alt="" aria-hidden="true" class="image-modal-icon" src="https://medlineplus.gov/css/img/icon_camera_small.png"/></a>, which means both copies of the gene in each cell have mutations. The parents of an individual with an autosomal recessive condition each carry one copy of the mutated gene, but they typically do not show signs and symptoms of the condition.</p></div>
|
||
</section>
|
||
|
||
</div>
|
||
<div class="mp-exp exp-full" data-bookmark="synonyms">
|
||
<h2>Other Names for This Condition</h2>
|
||
|
||
<section>
|
||
<ul class="bulletlist">
|
||
<li>Adult Refsum disease</li> <li>ARD</li> <li>Classic Refsum disease</li> <li>CRD</li> <li>Hereditary motor and sensory neuropathy type IV</li> <li>Heredopathia atactica polyneuritiformis</li> <li>HMSN IV</li> <li>HMSN type IV</li> <li>Phytanic acid storage disease</li> <li>Refsum syndrome</li> <li>Refsum's disease</li>
|
||
</ul>
|
||
</section>
|
||
|
||
</div>
|
||
|
||
<div class="mp-exp exp-full" data-bookmark="resources">
|
||
<h2>Additional Information & Resources</h2>
|
||
|
||
<section>
|
||
<div class="mp-content">
|
||
|
||
<h2>Genetic Testing Information</h2>
|
||
<ul>
|
||
|
||
<li><a href="https://www.ncbi.nlm.nih.gov/gtr/conditions/C0034960/" target="TheNewWin">Genetic Testing Registry: Phytanic acid storage disease</a> <span class="desc-text"><img alt="From the National Institutes of Health" title="From the National Institutes of Health" src="https://medlineplus.gov/images/nih.png" class="imgdesc" width="25" height="16"></span></li>
|
||
|
||
</ul>
|
||
|
||
</div>
|
||
</section>
|
||
|
||
<section>
|
||
<div class="mp-content">
|
||
|
||
<h2>Genetic and Rare Diseases Information Center</h2>
|
||
<ul>
|
||
|
||
<li><a href="https://rarediseases.info.nih.gov/diseases/5694/index" target="TheNewWin">Retinitis pigmentosa</a> <span class="desc-text"><img alt="From the National Institutes of Health" title="From the National Institutes of Health" src="https://medlineplus.gov/images/nih.png" class="imgdesc" width="25" height="16"></span></li>
|
||
|
||
</ul>
|
||
|
||
</div>
|
||
</section>
|
||
|
||
<section>
|
||
<div class="mp-content">
|
||
|
||
<h2>Patient Support and Advocacy Resources</h2>
|
||
<ul>
|
||
|
||
<li><a href="https://rarediseases.org/" target="TheNewWin">National Organization for Rare Disorders (NORD)</a></li>
|
||
|
||
</ul>
|
||
|
||
</div>
|
||
</section>
|
||
|
||
<section>
|
||
<div class="mp-content">
|
||
|
||
<h2>Clinical Trials</h2>
|
||
<ul>
|
||
|
||
<li><a href="https://clinicaltrials.gov/search?cond=%22Refsum disease%22" target="TheNewWin">ClinicalTrials.gov</a> <span class="desc-text"><img alt="From the National Institutes of Health" title="From the National Institutes of Health" src="https://medlineplus.gov/images/nih.png" class="imgdesc" width="25" height="16"></span></li>
|
||
|
||
</ul>
|
||
|
||
</div>
|
||
</section>
|
||
|
||
<section>
|
||
<div class="mp-content">
|
||
|
||
<h2>Catalog of Genes and Diseases from OMIM</h2>
|
||
<ul>
|
||
|
||
<li><a href="https://omim.org/entry/266500" target="TheNewWin">REFSUM DISEASE, CLASSIC</a></li>
|
||
|
||
</ul>
|
||
|
||
</div>
|
||
</section>
|
||
|
||
<section>
|
||
<div class="mp-content">
|
||
|
||
<h2>Scientific Articles on PubMed</h2>
|
||
<ul>
|
||
|
||
<li><a href="https://pubmed.ncbi.nlm.nih.gov/?term=%28Refsum*+disease%5BTIAB%5D%29+AND+english%5Bla%5D+AND+human%5Bmh%5D+AND+%22last+3600+days%22%5Bdp%5D" target="TheNewWin">PubMed</a> <span class="desc-text"><img alt="From the National Institutes of Health" title="From the National Institutes of Health" src="https://medlineplus.gov/images/nih.png" class="imgdesc" width="25" height="16"></span></li>
|
||
|
||
</ul>
|
||
|
||
</div>
|
||
</section>
|
||
|
||
</div>
|
||
|
||
<div class="mp-exp exp-full" data-bookmark="references">
|
||
<h2>References</h2>
|
||
|
||
<section>
|
||
<div class="mp-content">
|
||
|
||
<ul>
|
||
|
||
<li>Jansen GA, Waterham HR, Wanders RJ. Molecular basis of Refsum disease:
|
||
sequence variations in phytanoyl-CoA hydroxylase (PHYH) and the PTS2 receptor
|
||
(PEX7). Hum Mutat. 2004 Mar;23(3):209-18. doi: 10.1002/humu.10315. <a href="https://pubmed.ncbi.nlm.nih.gov/14974078" target="TheNewWin">Citation on PubMed</a></li>
|
||
|
||
|
||
<li>Ruether K, Baldwin E, Casteels M, Feher MD, Horn M, Kuranoff S, Leroy BP,
|
||
Wanders RJ, Wierzbicki AS. Adult Refsum disease: a form of tapetoretinal
|
||
dystrophy accessible to therapy. Surv Ophthalmol. 2010 Nov-Dec;55(6):531-8. doi:
|
||
10.1016/j.survophthal.2010.03.007. Epub 2010 Sep 20. <a href="https://pubmed.ncbi.nlm.nih.gov/20850855" target="TheNewWin">Citation on PubMed</a></li>
|
||
|
||
|
||
<li>Van den Brink DM, Brites P, Haasjes J, Wierzbicki AS, Mitchell J,
|
||
Lambert-Hamill M, de Belleroche J, Jansen GA, Waterham HR, Wanders RJ.
|
||
Identification of PEX7 as the second gene involved in Refsum disease. Adv Exp Med
|
||
Biol. 2003;544:69-70. doi: 10.1007/978-1-4419-9072-3_9. No abstract available.
|
||
<a href="https://pubmed.ncbi.nlm.nih.gov/14713215" target="TheNewWin">Citation on PubMed</a></li>
|
||
|
||
|
||
<li>van den Brink DM, Wanders RJ. Phytanic acid: production from phytol, its
|
||
breakdown and role in human disease. Cell Mol Life Sci. 2006 Aug;63(15):1752-65.
|
||
doi: 10.1007/s00018-005-5463-y. <a href="https://pubmed.ncbi.nlm.nih.gov/16799769" target="TheNewWin">Citation on PubMed</a></li>
|
||
|
||
|
||
<li>Wanders RJ, Jansen GA, Skjeldal OH. Refsum disease, peroxisomes and phytanic
|
||
acid oxidation: a review. J Neuropathol Exp Neurol. 2001 Nov;60(11):1021-31. doi:
|
||
10.1093/jnen/60.11.1021. <a href="https://pubmed.ncbi.nlm.nih.gov/11706932" target="TheNewWin">Citation on PubMed</a></li>
|
||
|
||
|
||
<li>Wanders RJ, Komen JC. Peroxisomes, Refsum's disease and the alpha- and
|
||
omega-oxidation of phytanic acid. Biochem Soc Trans. 2007 Nov;35(Pt 5):865-9.
|
||
doi: 10.1042/BST0350865. <a href="https://pubmed.ncbi.nlm.nih.gov/17956234" target="TheNewWin">Citation on PubMed</a></li>
|
||
|
||
|
||
<li>Waterham HR, Wanders RJA, Leroy BP. Adult Refsum Disease. 2006 Mar 20 [updated
|
||
2021 Sep 30]. In: Adam MP, Feldman J, Mirzaa GM, Pagon RA, Wallace SE, Amemiya A,
|
||
editors. GeneReviews(R) [Internet]. Seattle (WA): University of
|
||
Washington, Seattle; 1993-2025. Available from
|
||
http://www.ncbi.nlm.nih.gov/books/NBK1353/
|
||
<a href="https://pubmed.ncbi.nlm.nih.gov/20301527" target="TheNewWin">Citation on PubMed</a></li>
|
||
|
||
|
||
<li>Wierzbicki AS, Lloyd MD, Schofield CJ, Feher MD, Gibberd FB. Refsum's disease:
|
||
a peroxisomal disorder affecting phytanic acid alpha-oxidation. J Neurochem. 2002
|
||
Mar;80(5):727-35. doi: 10.1046/j.0022-3042.2002.00766.x. <a href="https://pubmed.ncbi.nlm.nih.gov/11948235" target="TheNewWin">Citation on PubMed</a></li>
|
||
|
||
|
||
<li>Wierzbicki AS. Peroxisomal disorders affecting phytanic acid alpha-oxidation:
|
||
a review. Biochem Soc Trans. 2007 Nov;35(Pt 5):881-6. doi: 10.1042/BST0350881.
|
||
<a href="https://pubmed.ncbi.nlm.nih.gov/17956237" target="TheNewWin">Citation on PubMed</a></li>
|
||
|
||
|
||
</ul>
|
||
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