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X-linked adrenoleukodystrophy.
[adrenomyeloneuropathy]
X-
linked
adrenoleukodystrophy
(
X-
ALD
)
is
caused
by
a
defect
in
the
gene
ABCD
1
,
which
maps
to
Xq
28
and
codes
for
a
peroxisomal
membrane
protein
that
is
a
member
of
the
ATP-binding
cassette
transporter
superfamily
.
X-
ALD
is
panethnic
and
affects
approximately
1
:
20
,
000
males
.
Phenotypes
include
the
rapidly
progressive
childhood
,
adolescent
,
and
adult
cerebral
forms
;
adrenomyeloneuropathy
,
which
presents
as
slowly
progressive
paraparesis
in
adults
;
and
Addison
disease
without
neurologic
manifestations
.
These
phenotypes
are
frequently
misdiagnosed
,
respectively
,
as
attention
-deficit
hyperactivity
disorder
(
ADHD
)
,
multiple
sclerosis
,
or
idiopathic
Addison
disease
.
Approximately
50
%
of
female
carriers
develop
a
spastic
paraparesis
secondary
to
myelopathic
changes
similar
to
adrenomyeloneuropathy
.
Assays
of
very
long
chain
fatty
acids
in
plasma
,
cultured
chorion
villus
cells
and
amniocytes
,
and
mutation
analysis
permit
presymptomatic
and
prenatal
diagnosis
,
as
well
as
carrier
identification
.
The
timely
use
of
these
assays
is
essential
for
genetic
counseling
and
therapy
.
Early
diagnosis
and
treatment
can
prevent
overt
Addison
disease
,
and
significantly
reduce
the
frequency
of
the
severe
childhood
cerebral
phenotype
.
A
promising
new
method
for
mass
newborn
screening
has
been
developed
,
the
implementation
of
which
will
have
a
profound
effect
on
the
diagnosis
and
therapy
of
X-
ALD
.
Diseases
Validation
Diseases presenting
"cerebral phenotype"
symptom
adrenomyeloneuropathy
x-linked adrenoleukodystrophy
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