저자들은 4년 전 모야모야병으로 진단되어 수술 받았던 16세의 여아에서 지속적으로 고지질혈증이 있어 검사를 시행한 결과 가족 중 여동생에게서도 고지질혈증이 있음이 확인되었고 대사성산증, 고요산혈증, 젖산혈증 및 간비대가 지속되어 시행했던 염기 서열 분석에서 당원병 type Ia로 진단된 1례를 경험하였기에 보고하는 바이다.

Purpose Phenylketonuria is an inborn error of metabolism, which is inherited as an autosomal recessive trait. PKU is resulting from deficiency of phenylalanine hydroxylase. PAH gene spans about 90 kb on chromosome 12q and comprises 13 exons. In order to define the genetic basis of PKU and the frequencies and distribution of PAH mutations in the Korean population, we analyzed PAH gene in independent 80 patients with PKU. Methods All 13 exons including exon-intron boundaries and 2 kb of 5' upstream region of the PAH gene were analyzed by PCR-direct sequencing methods. Results PAH gene analysis revealed 39 different mutations including 10 novel mutations. The novel mutations consisted of 9 missense mutations (P69S, G103S, N207D, T278S, P281A, L293M, G332V, S391I and A447P) and a novel splice site variant (IVS10-3C>G). R243Q, IVS4-1G>A, and E6-96A>G were the most relevant mutations and they accounted in the whole for 38% of the mutant alleles identified in this study. We also observed that. $BH_4$ responsibility was. associated with genotype of R241C, R53H and R408Q. Conc1ustion Our present study with 80 participants extends the previous results to more comprehensive understanding of PAH allele distribution and frequency in Koreans. Although Korean mutation profile of PAH is similar to those of the nearest oriental populations (Japanese, Chinese, and Taiwanese), several different characteristic features are revealed. The characterization of the genotype-phenotype relationship was also performed. Our data would be very useful information for diagnosis, genetic counseling and planning of dietary and therapeutic strategies in Korean PAH patients.

저자들은 생후 28일된 발열, 간종대, 출혈성 경향, 구토, 잦은 보챔, 전신의 황달 증상을 보이던 환아를 MS-MS 이용한 신생아 대사 이상 검사와 혈중 아미노산 분석, 뇨중 유기산 분석을 통하여 hereditary tyrosinemia type I으로 진단하였다. 저 페닐알라닌/타이로신 식이와 NTBC 사용으로 국내 첫 타이로신혈증 I 치료 성공례를 경험하였다.

시스틴증은 상염색체 열성으로 발생하는 매우 드문 용해소체 축적병으로서, 용해소체 막을 통한 시스틴 운반의 장애로 발생한다. 용해소체 내 시스틴의 축척과 결정화에 의해 전신의 여러 조직에 파괴가 진행되어 성장 장애, Fanconi 증후군, 신부전, 눈의 이상, 내분비 질환 등이 나타난다. 치료제인 cysteamine의 투여가 예후를 향상시킬 수 있으므로 조기 진단과 치료가 중요하다. 저자들은 성장 장애를 주소로 내원한 12세 남아에서 slit-lamp 검사와 혈액 백혈구 시스틴 농도 측정을 통하여 시스틴증을 확진하고 cysteamine 치료를 시행하면서 추적 관찰 중이다.

3-Methylcrotonyl-CoA carboxylase (MCC) is a biotin-dependent enzyme involved in leucine metabolism. We describe a patient with MCC deficiency who manifested with Reye syndrome-like illness with status epilepticus, metabolic acidosis, hypoglycemia, hyperammonemia, elevated liver enzymes and neurologic impairments after the viral gastroenteritis and then, has suffered from Lennox-Gastaut syndrome. Urinary organic acid analysis revealed increased excretion of 3-hydroxyisovaleric acid and 3-methylcrotonylglycine. This patient was managed with leucine restriction diet and supplementation of biotin and carnitine but was not so effective. He has suffered from neurologic sequelae such as Lennox-Gastaut syndrome, motor and cognitive impairement.