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[Porphyrias].
[erythropoietic protoporphyria]
Porphyrias
are
metabolic
disorders
of
the
heme
biosynthesis
.
Clinically
,
they
can
be
differentiated
into
acute
and
non-
acute
porphyrias
.
The
symptomatic
phase
of
acute
hepatic
porphyrias
is
characterized
by
overproduction
of
neurotoxic
porphyrin
precursors
and
porphyrins
.
Acute
intermittent
porphyria
,
Variegate
porphyria
,
Hereditary
coproporphyria
and
Doss
porphyria
belong
to
this
group
of
metabolic
disorders
.
The
clinical
presentation
of
the
acute
hepatic
porphyria
syndrome
includes
abdominal
,
psychiatric
,
neurological
and
cardiovascular
symptoms
.
The
diagnosis
is
based
on
a
tenfold
increased
urinary
excretion
of
porphobilinogen
(
apart
from
Doss
porphyria
)
.
Besides
symptomatic
therapy
with
non-porphyrinogenic
drugs
,
electrolyte
compensation
and
intensive
monitoring
,
intravenous
administration
of
glucose
and
heme
arginate
is
established
for
treatment
.
Among
the
non-
acute
types
like
Porphyria
cutanea
tarda
,
Erythropoietic
protoporphyria
and
Congenital
erythropoietic
porphyria
,
the
accumulated
porphyrins
cause
photosensitivity
of
the
skin
up
to
severe
liver
damage
.
The
location
of
the
deficient
enzyme
within
the
heme
biosynthesic
pathway
determines
the
pattern
of
the
accumulated
porphyrins
.
Besides
light
protection
,
there
are
different
therapies
depending
on
the
type
of
non-
acute
porphyria
.
Ultimately
,
liver
transplantation
may
be
considered
in
therapy-resistant
cases
of
acute
hepatic
porphyrias
and
bone
marrow
transplantation
in
severe
cases
of
erythropoietic
porphyrias
.
Diseases
Validation
Diseases presenting
"liver damage"
symptom
benign recurrent intrahepatic cholestasis
erythropoietic protoporphyria
neonatal adrenoleukodystrophy
scrub typhus
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