eMedicine Specialties > Pediatrics: Genetics and Metabolic Disease > Metabolic Diseases
Argininosuccinate Lyase Deficiency: Differential Diagnoses & Workup
Updated: Mar 24, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Differential Diagnoses
Other Problems to Be Considered
Organic acid disorders (eg, isovaleric acidemia)
Lysinuric protein intolerance
Transient hyperammonemia of the newborn
Hepatic insufficiency or dysfunction
Mitochondrial diseases and pyruvate carboxylase deficiency
Valproate ingestion
L-Asparaginase ingestion
Reye syndrome
Workup
Laboratory Studies
- No routine laboratory data assist diagnosis of argininosuccinate (ASA) lyase deficiency.
- BUN testing is subject to numerous factors aside from the rate of production via the urea cycle. Among the most obvious is the state of hydration, which frequently causes an artifactual increase to a normal concentration in a very sick infant.
- A very low BUN level is suggestive but must never be relied on as a diagnostic indicator.
- As with all other urea cycle disorders, clinical suspicion is essential and should prompt the clinician to obtain blood ammonia levels, which are significantly elevated in symptomatic patients. This finding should lead to an immediate blood and urine amino acid quantitation, which confirms the presence of argininosuccinic acid in both fluids. In addition, levels of blood citrulline, glutamine, alanine, and lysine may be increased. Argininosuccinic acid lyase may be assayed in cultured fibroblasts, providing the definitive biochemical diagnosis. Urine orotic acid levels are elevated.
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Differential Diagnoses & Workup: Argininosuccinate Lyase Deficiency |
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| Follow-up: Argininosuccinate Lyase Deficiency |
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References
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Stadler S, Gempel K, Bieger I, et al. Detection of neonatal argininosuccinate lyase deficiency by serum tandem mass spectrometry. J Inherit Metab Dis. Jun 2001;24(3):370-8. [Medline].
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Stephenne X, Najimi M, Sibille C, Nassogne MC, Smets F, Sokal EM. Sustained engraftment and tissue enzyme activity after liver cell transplantation for argininosuccinate lyase deficiency. Gastroenterology. Apr 2006;130(4):1317-23. [Medline].
Trevisson E, Salviati L, Baldoin MC, et al. Argininosuccinate lyase deficiency: mutational spectrum in Italian patients and identification of a novel ASL pseudogene. Hum Mutat. Feb 26 2007;28(7):694-702. [Medline].
Widhalm K, Koch S, Scheibenreiter S, et al. Long-term follow-up of 12 patients with the late-onset variant of argininosuccinic acid lyase deficiency: no impairment of intellectual and psychomotor development during therapy. Pediatrics. Jun 1992;89(6 Pt 2):1182-4. [Medline].
Further Reading
Keywords
argininosuccinase, ASA, argininosuccinase lyase deficiency, ASA lyase deficiency, argininosuccinic aciduria, argininosuccinase deficiency, hyperammonemia, hepatic urea cycle, -acetylglutamate, carbamyl phosphate synthetase, CPS, trichorrhexis nodosa, friable hair, choreoathetotic movement disorder, ASL deficiency, diagnosis, treatment, mental retardation, respiratory failure
Differential Diagnoses & Workup: Argininosuccinate Lyase Deficiency