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Adult-onset glutaric aciduria type I: rare presentation of a treatable disorder

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Abstract

Glutaric aciduria type I (GA1; OMIM #231670) is an autosomal recessively inherited and treatable disorder characterized by the accumulation and irregular excretion of glutaric acid due to a defect in the glutaryl-CoA dehydrogenase enzyme involved in the catabolic pathways of l-lysine, l-hydroxylysine, and l-tryptophan. Glutaryl-CoA dehydrogenase is encoded by the GCDH gene (OMIM #608801), and several mutations in this gene are known to result in GA1. GA1 usually presents in the first 18–36 months of life with mild or severe acute encephalopathy, movement disorders, and striatal degeneration. Few cases of adult-onset GA1 have been described so far in the literature, often with non-specific and sometimes longstanding neurological symptoms. Since a preventive metabolic treatment is available, neurologists must be aware of this rare but likely underdiagnosed presentation, especially when typical neuroimaging features are identified. Here, we describe 35-year-old presenting with headache and subjective memory problems. There was no history of dystonic movement disorders. Neurological examination and neurocognitive tests were normal. Brain MRI scan revealed white matter abnormalities associated with subependymal nodules and mild frontotemporal hypoplasia suggestive of glutaric aciduria type 1 (GA1). Genetic testing confirmed the presence of homozygous c.1204C > T (p.R402W) variant in the GCDH gene, inherited from heterozygous parents.

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Authors and Affiliations

  1. Department of Neurology, University of Kyrenia Faculty of Medicine, Kyrenia, Cyprus

    Pınar Gelener

  2. Department of Neurology, Near East University Faculty of Medicine, Nicosia, Cyprus

    Pınar Gelener & Sevda Diker

  3. Department of Neuroradiology, IRCCS Istituto Giannina Gaslini, Genova, Italy

    Mariasavina Severino & Hatice Tuzlalı

  4. Department of Medical Biochemistry, Faculty of Medicine, Near East University, Nicosia, Cyprus

    Kerem Teralı

  5. Department of Medical Biology, Faculty of Medicine, Near East University, Nicosia, Cyprus

    Gulten Tuncel & Mahmut Cerkez Ergoren

  6. DESAM Institute, Near East University, Nicosia, Cyprus

    Gulten Tuncel & Mahmut Cerkez Ergoren

  7. MAGI Euregio, Bolzano, Italy

    Elena Manara & Stefano Paolacci

  8. MAGI’s LAB S.r.l., Rovereto, Italy

    Matteo Bertelli

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  1. Pınar Gelener
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Gelener, P., Severino, M., Diker, S. et al. Adult-onset glutaric aciduria type I: rare presentation of a treatable disorder. Neurogenetics 21, 179–186 (2020). https://doi.org/10.1007/s10048-020-00610-9

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  • DOI: https://doi.org/10.1007/s10048-020-00610-9

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