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Tryptophan Metabolism Disorders (Hartnup's Disease)

Hartnup's Disease

• There is a defect in the transport of neutral amino acids (monobasic-monocarboxylic amino acids; alanine, serine, threonine, valine, leucine, isoleucine, phenylalanine, tyrosine, tryptophan) through the small intestine mucosa and renal tubules. It is autosomal recessive.

• Clinical findings occur due to impaired intestinal absorption of nicotinic acid (Niacin) and tryptophan, a precursor of nicotinamide. Similar to pellagra, photosensitivity of the skin and dermatitis in sun-exposed areas are major symptoms. There is cerebellar ataxia.

Mental development is usually normal. In some cases, emotional disorders, depression, and suicidal tendencies may occur.

• Neutral aminoaciduria is seen in the urine; however, unlike Fanconi syndrome, arginine and proline are not detected in the urine.

Nicotinamide, which is given twice the daily dose in symptomatic patients, controls skin and neurological findings. The diet of patients should be high in protein.


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