Tyrosinemia (TYR I)
Differential Diagnosis: Tyrosinemia I (hepatorenal); tyrosinemia II (oculocutaneous); tyrosinemia III; transient hypertyrosinemia; liver disease.
Condition Description: In the hepatorenal form, tyrosine from ingested protein and phenylalanine metabolism cannot be metabolized by fumarylacetoacetate hydrolase to fumaric acid and acetoacetic acid. The resulting fumarylacetoacetate accumulates and is converted to succinylacetone, the diagnostic metabolic which is liver toxic and leads to elevated tyrosine. Tyrosinemia II and III are due to other defects in tyrosine degradation.
YOU SHOULD TAKE THE FOLLOWING IMMEDIATE ACTIONS:
- Contact family to inform them of the newborn screening result
- Consult with pediatric metabolic specialist
- Evaluate the newborn and refer as appropriate
- Initiate timely confirmatory/diagnostic tests in consultation with metabolic specialist
- Provide family with basic information about Tyrosinemia
- Report findings to state newborn screening program (Carleigh Soule at 307-777-6297)
Diagnostic Evaluation: Plasma amino acid analysis will show increased tyrosine in all of the tyrosinemias. Urine organic analysis will reveal increased succinylacetone in tyrosinemia I.
Clinical Considerations: Tyrosinemia I is usually asymptomatic in the neonate. If untreated, it will cause liver disease and cirrhosis early in infancy. Nitisinone (NTBC) treatment will usually prevent these features. Tyrosinemia II is asymptomatic in the neonate but will cause hyperkeratosis of the skin, corneal ulcers, and in some cases, mental retardation unless treated with a tyrosine restricted diet. Tyrosinemia III may be benign.
Additional Information: (Click on the name to take you to the website)
Genetic Home Reference Wyoming Department of Health
New England Consortium Colorado Newborn Screening
American Academy of Pediatrics http://pediatrics.aappublications.org/
For Algorithm: http://www.acmg.net/resources/policies/ACT/Visio-Tyrosine-(4-18-06).pdf