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Abetalipoproteinaemia
MTTP AR
Fat malabsorption, acanthocytosis, retinitis pigmentosa, ataxia, fat-soluble vitamin deficiency
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Acute intermittent porphyria
HMBS AD
Abdominal pain, neuropathy, psychiatric signs, port-wine urine; NO photosensitivity; triggered by CYP inducers, fasting, alcohol
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Adenosine deaminase deficiency
ADA AR
Severe combined immunodeficiency; absent T, B and NK cells
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Alkaptonuria
HGD AR
Urine darkens on standing, ochronosis of cartilage, degenerative arthritis
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Andersen disease (GSD IV)
GBE1 AR
Cirrhosis, failure to thrive, early death
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Argininosuccinic aciduria
ASL AR
Hyperammonaemia, trichorrhexis nodosa (brittle hair)
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Citrullinaemia type I
ASS1 AR
Hyperammonaemia, vomiting, encephalopathy
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Classic galactosaemia
GALT AR
Cataracts, jaundice, hepatomegaly, intellectual disability, E. coli sepsis
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Cori-Forbes disease (GSD III)
AGL AR
Milder than GSD I; normal lactate, hepatomegaly, myopathy
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CPS I deficiency
CPS1 AR
Neonatal hyperammonaemia, lethargy, coma
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CPT-I deficiency
CPT1A AR
Hypoketotic hypoglycaemia, hepatomegaly; normal or high carnitine
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CPT-II deficiency
CPT2 AR
Adult form: rhabdomyolysis after prolonged exercise or fasting
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Crigler-Najjar syndrome type I
UGT1A1 AR
Severe neonatal jaundice, kernicterus, death without transplant
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Cyanide / carbon monoxide poisoning
(acquired) Acquired
Headache, coma, lactic acidosis; cherry-red skin in CO; bitter-almond odour in cyanide
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Cystinuria
SLC3A1 / SLC7A9 AR
Recurrent hexagonal cystine kidney stones
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Diabetic ketoacidosis
(acquired) Acquired
Hyperglycaemia, high anion-gap acidosis, Kussmaul breathing, acetone breath, dehydration
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Dubin-Johnson syndrome
ABCC2 AR
Conjugated hyperbilirubinaemia; grossly black liver
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Essential fructosuria
KHK AR
Benign; asymptomatic
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Essential pentosuria
DCXR AR
Benign; incidental urinary reducing substance
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Fabry disease
GLA XR
Angiokeratomas, acroparaesthesia, hypohidrosis, renal failure, cardiomyopathy, stroke
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Familial chylomicronaemia (type I)
LPL / APOC2 AR
Eruptive xanthomas, lipaemia retinalis, recurrent pancreatitis; creamy supernatant
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Familial hypercholesterolaemia
LDLR / APOB / PCSK9 AD
Tendon xanthomas, xanthelasma, corneal arcus, premature coronary disease
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Fructose-1,6-bisphosphatase deficiency
FBP1 AR
Fasting hypoglycaemia with lactic acidosis and ketosis, hyperventilation
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G6PD deficiency
G6PD XR
Episodic haemolysis with oxidants (primaquine, sulfonamides, nitrofurantoin, dapsone, fava beans, infection); Heinz bodies, bite cells
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Galactokinase deficiency
GALK1 AR
Isolated cataracts, no hepatic or CNS disease
-
Gaucher disease
GBA AR
Hepatosplenomegaly, pancytopenia, bone crises, Gaucher (crumpled-tissue-paper) cells
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Gilbert syndrome
UGT1A1 AR / polymorphism
Mild intermittent jaundice with fasting, illness or stress; otherwise benign
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Gout
(multifactorial) Multifactorial
Acute podagra; negatively birefringent needle-shaped crystals; tophi
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Hereditary fructose intolerance
ALDOB AR
Vomiting, hypoglycaemia, jaundice, cirrhosis after fructose/sucrose; aversion to sweets
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Hereditary orotic aciduria
UMPS AR
Megaloblastic anaemia NOT responsive to B12 or folate, failure to thrive; NO hyperammonaemia (unlike OTC deficiency)
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Homocystinuria (CBS deficiency)
CBS AR
Marfanoid habitus, DOWNWARD lens dislocation, thrombosis, intellectual disability, osteoporosis
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Krabbe disease
GALC AR
Optic atrophy, peripheral neuropathy, globoid cells, developmental regression
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Lead poisoning
(acquired) Acquired
Microcytic anaemia with basophilic stippling, abdominal colic, wrist/foot drop, encephalopathy, gingival lead lines
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Leigh syndrome
mtDNA or nuclear Mitochondrial / AR
Subacute necrotising encephalomyelopathy; brainstem and basal ganglia lesions
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Lesch-Nyhan syndrome
HPRT1 XR
Hyperuricaemia, gout, orange sand in nappies, self-mutilation, choreoathetosis, intellectual disability
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Maple syrup urine disease
BCKDHA/B, DBT AR
Burnt-sugar/maple urine odour, poor feeding, ketoacidosis, encephalopathy
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MCAD deficiency
ACADM AR
Hypoketotic hypoglycaemia on fasting, vomiting, coma, SIDS-like death
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McArdle disease (GSD V)
PYGM AR
Exercise intolerance, cramps, myoglobinuria, second-wind phenomenon; normal blood glucose
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MELAS
MT-TL1 Mitochondrial
Mitochondrial encephalomyopathy, lactic acidosis, stroke-like episodes; ragged red fibres
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Metachromatic leukodystrophy
ARSA AR
Central and peripheral demyelination, ataxia, dementia
-
Methylmalonic acidaemia
MMUT / MMAA / MMAB AR
Ketoacidosis, hyperammonaemia, failure to thrive
-
Niemann-Pick disease A/B
SMPD1 AR
Hepatosplenomegaly, cherry-red macula, neurodegeneration (type A), foam cells
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Oculocutaneous albinism
TYR AR
Hypopigmentation of skin/hair/eyes, photophobia, nystagmus, high skin cancer risk
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OTC deficiency
OTC XLD
Commonest urea cycle defect; hyperammonaemia, vomiting, encephalopathy; low BUN, no megaloblastic anaemia
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Phenylketonuria
PAH / PTS / QDPR AR
Intellectual disability, musty odour, hypopigmentation, eczema, seizures
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Pompe disease (GSD II)
GAA AR
Cardiomegaly, hypotonia, early death in infantile form
-
Porphyria cutanea tarda
UROD AD / acquired
Commonest porphyria; blistering photosensitivity, hypertrichosis, tea-coloured urine; linked to HCV, alcohol, iron, oestrogen
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Primary carnitine deficiency
SLC22A5 AR
Cardiomyopathy, hypotonia, hypoketotic hypoglycaemia
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Propionic acidaemia
PCCA / PCCB AR
Ketoacidosis, hyperammonaemia, vomiting, hypotonia
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Pyruvate carboxylase deficiency
PC AR
Lactic acidosis, hypoglycaemia, neurological disease
-
Pyruvate dehydrogenase complex deficiency
PDHA1 XLD
Congenital lactic acidosis, neurological impairment; worsened by high-carbohydrate diet
-
Pyruvate kinase deficiency
PKLR AR
Chronic non-spherocytic haemolytic anaemia; right-shifted O2 curve
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Tangier disease
ABCA1 AR
Near-absent HDL, orange tonsils, hepatosplenomegaly, neuropathy
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Tarui disease (GSD VII)
PFKM AR
Exercise intolerance with haemolysis; no second wind
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Tay-Sachs disease
HEXA AR
Cherry-red macula, hyperacusis/startle, progressive neurodegeneration; NO hepatosplenomegaly
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Tyrosinaemia type I
FAH AR
Liver failure, renal Fanconi syndrome, hepatocellular carcinoma, cabbage-like odour
-
Von Gierke disease (GSD I)
G6PC / SLC37A4 AR
Severe fasting hypoglycaemia, lactic acidosis, hyperuricaemia, hyperlipidaemia, doll-like facies, hepatomegaly
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Wernicke-Korsakoff syndrome
(acquired B1 deficiency) Acquired
Confusion, ophthalmoplegia, ataxia; then confabulation and amnesia
-
X-linked adrenoleukodystrophy
ABCD1 XR
Adrenal insufficiency with progressive demyelination and behavioural change
-
X-linked sideroblastic anaemia
ALAS2 XR
Microcytic anaemia with ringed sideroblasts and iron overload
-
Zellweger syndrome
PEX genes AR
Hypotonia, seizures, craniofacial dysmorphism, hepatomegaly, early death