NOV 08, 2015
- Caused by mutations in PTS1 receptor gene (PXR1, OMIM 600414), peroxin-1 gene (PEX1, OMIM 602136), peroxin-10 gene (PEX10, OMIM 602859), and peroxin-13 gene (PEX13, OMIM 601789)
- Onset is in the first few days of life, with severe psychomotor retardation, opisthotonus, and seizures.
- There is extensive demyelination of the brain.
- Patients have adrenal insufficiency and later become deaf and blind.
- Death occurs between the ages of 1 and 9 years.
- There are increased serum levels of very long chain fatty acids (VLCFAs) and decreased plasmalogen levels.
- Abnormal retinal pigmentation, with "leopard spots" and optic atrophy (Figure 1).
- The electroretinogram is nonrecordable.
- Other ocular findings include neonatal polar cataracts and strabismus.
Figure 1. Leopard-spot retinopathy in an infant with neonatal adrenoleukodystrophy (courtesy of Sprague Eustis, MD).
- Patients are treated with Docohexanoic acid (DHA) with stabilization of retinopathy and some improvement in general systemic clinical abnormalities.
- Al-Hazzaa SA, Ozand PT: Peroxisomal bifunctional enzyme deficiency with associated retinal findings. Ophthalmic Genet. 1997; 18:93-99.
- Cohen SM, Green WR, de la Cruz ZC, et al: Ocular histopathologic studies of neonatal and childhood adrenoleukodystrophy. Am J Ophthalmol. 1983; 95:82-96.
- Folz SJ, Trobe JD: The peroxisome and the eye. Surv Ophthalmol. 1991; 35:353-368.
- Maksoud SAA, El-Bassyouni HT, Afifi HH, Khalifa AG. The role of DHA in amelioration of symptoms of peroxisome biogenesis disorders. Res J Medicine Med Sci. 2007; 2:5-13.
Traboulsi EI. Compendium of Inherited Disorders and the Eye. New York: Oxford University Press; 2005. Adapted with permission.