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$Unique_ID{BRK03567}
$Pretitle{}
$Title{Carnitine Palmityltransferase Deficiency}
$Subject{Carnitine Palmityltransferase Deficiency CPTD CPT Deficiency Myopathy
with Deficiency of Carnitine Palmityltransferase Myopathy-Metabolic Carnitine
Palmityltransferase Deficiency Eaton-Lambert Syndrome Myopathy Scapuloperoneal
Fibromyalgia LCAD Deficiency}
$Volume{}
$Log{}
Copyright (C) 1992 National Organization for Rare Disorders, Inc.
915:
Carnitine Palmityltransferase Deficiency
** IMPORTANT **
It is possible that the main title of the article (Carnitine
Palmityltransferase Deficiency) is not the name you expected. Please check
the SYNONYM listing to find the alternate names and disorder subdivisions
covered by this article.
Synonyms
CPTD
CPT Deficiency
Myopathy with Deficiency of Carnitine Palmityltransferase
Myopathy-Metabolic, Carnitine Palmityltransferase Deficiency
Information on the following diseases can be found in the Related
Disorders section of this report:
Eaton-Lambert Syndrome
Myopathy, Scapuloperoneal
Fibromyalgia
LCAD Deficiency
General Discussion
** REMINDER **
The Information contained in the Rare Disease Database is provided for
educational purposes only. It should not be used for diagnostic or treatment
purposes. If you wish to obtain more information about this disorder, please
contact your personal physician and/or the agencies listed in the "Resources"
section of this report.
Carnitine Palmityltransferase Deficiency is a metabolic disorder that
affects the muscle's ability to function properly. It is a very rare genetic
disorder. CPT Deficiency is a disease of muscle fat (lipid) metabolism.
Strenuous exercise triggers the symptoms which leads to breakdown of muscle
tissue and appearance of muscle hemoglobin in the urine. Major symptoms may
include muscle pain, fatigue and passing of dark red-brown urine
(myoglobinuria) after strenuous exercise.
Symptoms
Carnitine Palmityltransferase Deficiency is a very rare metabolic disease.
It is characterized by easy fatigue during prolonged exercise, disabling
muscle pain that sometimes lasts for days and fat (lipid) levels in the
muscles that usually remain the same or increase only slightly. Destruction
of skeletal muscles (rhabdomyolysis) is sometimes followed by passage of red-
brown urine (myoglobinuria). The combination of these conditions may
sometimes become life-threatening.
CPT Deficiency is more apparent in diabetics and cases of malnutrition.
The disorder usually becomes noticeable during adulthood but may affect
children in a more serious form. Life-threatening rhabdomyolysis and
myoglobinuria may follow prolonged exercise, viral illness, sleep and food
deprivation and over-exposure to cold, especially in diabetic patients or
persons on a high fat diet. As a precaution, siblings of CPT patients should
be tested for the disorder to help prevent possible development of the
symptoms.
Causes
Carnitine Palmityltransferase Deficiency is thought to be caused by an
autosomal recessive mode of inheritance. Human traits, including the classic
genetic diseases, are the product of the interaction of two genes, one
received from the father and one from the mother. In autosomal recessive
disorders the condition does not appear unless a person inherits the same
defective gene from the same trait from each parent. If one receives one
normal gene and one gene for the disease, the person will be a carrier for
the disease, but usually will not show symptoms. The risk of transmitting
the disease to the children of a couple, both of whom are carriers for a
recessive disorder, is twenty-five percent. Fifty percent of their children
will be carriers, but healthy as described above. Twenty-five percent of
their children will receive both normal genes, one from each parent, and will
be genetically normal.
CPT Deficiency usually affects adults. However, a more serious form of
the disorder sometimes affects children. Symptoms can occur as a response to
extreme stress, over-exercise, malnutrition and cold, especially in diabetic
persons with the disorder. Muscle fat levels usually remain the same or are
only slightly elevated during attacks, and there are usually no symptoms
between attacks.
The gene responsible for the disorder is assigned to chromosome 1 in the
region of 1q12-1pter.
Affected Population
Carnitine Palmityltransferase Deficiency is a very rare disorder that is
discovered in males more often than females. It usually becomes apparent in
adulthood. However, a more serious form may affect children. When this
disorder is diagnosed in a family each child of that couple should be checked
to determine whether others are affected by CPT Deficiency so precautions can
be taken to avoid the symptoms of the illness.
Related Disorders
Symptoms of the following disorders can be similar to those of Carnitine
Palmityltransferase Deficiency. Comparisons may be useful for a differential
diagnosis:
Eaton-Lambert Syndrome is a neuromuscular disorder that includes muscle
weakness and fatigue especially of the pelvic and thigh muscles. Patients
may not have deep tendon reflexes and lower limbs are affected more often
than upper limbs. (For more information on this disorder, choose "Eaton-
Lambert" as your search term in the Rare Disease Database).
Scapuloperoneal Myopathy is a genetic disorder characterized by a
weakness and wasting of muscles. Symptoms are usually limited to the
shoulder blade area and the smaller of the two leg muscle groups below the
knee. The disorder may begin in childhood or adulthood. (For more
information on this disorder, choose "Scaploperoneal Myopathy" as your search
term in the Rare Disease Database).
Fibromyalgia is a chronic disorder characterized by pain throughout much
of the body. The pain may begin gradually or have a sudden onset. Other
symptoms are muscle spasms, fatigue, muscle tissue stiffness and non-
restorative sleep. The exact cause of this disorder is unknown. (For more
information on this disorder, choose "Fibromyalgia" as your search term in
the Rare Disease Database).
LCAD Deficiency is a secondary Carnitine deficiency resulting in low
blood sugar, abnormal liver function, abnormally low ketones in the blood and
acidosis. Poor muscle tone, fatigue and vomiting occur after a viral
illness. This disorder can occur in any age group from the prenatal stage
into adulthood. Left untreated it can result in physical and mental
retardation and may become life threatening.
Therapies: Standard
Carnitine Palmityltransferase Deficiency can be diagnosed by enzymatic
studies and muscle biopsy. It is important for persons with this metabolic
problem to first be aware of the limitations of the disorder, especially if
the person is diabetic. Patients should exercise in moderation, eat adequate
amounts of food, avoid stress and high fat foods, and keep warm.
Supplementing carnitine in the diet is not helpful in CP Deficiency.
Genetic counseling may be of benefit for patients and their families.
Other treatment is symptomatic and supportive.
Therapies: Investigational
Research on inborn errors of metabolism is ongoing. Scientists are studying
the causes of these disorders and trying to design enzyme replacement
therapies that will return a missing enzyme to the body.
The National Institutes of Health (NIH) is sponsoring the Human Genome
Project which is aimed at mapping every gene in the human body and learning
why they sometimes malfunction. It is hoped that this new knowledge will
lead to prevention and treatment of genetic disorders in the future.
This disease entry is based upon medical information available through
May 1992. Since NORD's resources are limited, it is not possible to keep
every entry in the Rare Disease Database completely current and accurate.
Please check with the agencies listed in the Resources section for the most
current information about this disorder.
Resources
For more information on Carnitine Palmityltransferase Deficiency, please
contact:
National Organization for Rare Disorders (NORD)
P.O. Box 8923
New Fairfield, CT 06812-1783
(203) 746-6518
NIH/National Institute of Diabetes, Digestive & Kidney Diseases
9000 Rockville Pike
Bethesda, MD 20892
(301) 496-3583
Research Trust for Metabolic Diseases in Children
Golden Gates Lodge, Weston Road
Crewe CW1 1XN, England
(0270) 250244
For Genetic Information and Genetic Counseling Referrals:
March of Dimes Birth Defects Foundation
1275 Mamaroneck Avenue
White Plains, NY 10605
(914) 428-7100
Alliance of Genetic Support Groups
35 Wisconsin Circle, Suite 440
Chevy Chase, MD 20815
(800) 336-GENE
(301) 652-5553
References
MENDELIAN INHERITANCE IN MAN, 9th Ed.: Victor A. McKusick, Editor: Johns
Hopkins University Press, 1990. P. 1365.
THE METABOLIC BASIS OF INHERITED DISEASE, 6th Ed.: Charles R. Scriver, et
al., Editors; McGraw Hill, 1989. Pp. 388, 889, 911.
BIRTH DEFECTS ENCYCLOPEDIA, Mary Louise Buyse, M.D., Editor-In-Chief;
Blackwell Scientific Publications, 1990. Pp. 1200-1201.
REGULATION OF CARNITINE PALMITYLTRANSFERASE IN VIVO BY GLUCAGON AND
INSULIN. Brady, P.S. et al.; Biochem J, March 15, 1989, (issue 258 (3)).
Pp. 677-682.
CARNITINE PALMITYLTRANSFERASE IN HUMAN ERYTHROCYTE MEMBRANE. PROPERTIES
AND MALONYL-CoA SENSITIVITY. Ramsay, R.R., et al,; Biochem J, May 1, 1991,
(issue 275 (pt. 3)). Pp. 685-688.
CHRONIC MYOPATHY WITH A PARTIAL DEFICIENCY OF THE CARNITINE
PALMITYLTRANSFERASE ENZYME., Kieval, R.I., et al.; Arch Neurol, May, 1989,
(issue 46 (5)). Pp. 575-576.
FATAL RHABDOMYOLYSIS FOLLOWING INFLUENZA INFECTION IN A GIRL WITY
FAMILIAL CARNITINE PALMITYLTRANSFERASE DEFICIENCY., Kelly, K.J., et al.;
Pediatrics, August, 1989, (issue 84 (2)). Pp. 312-316.