by Rick Alan
X-linked adrenoleukodystrophy (ALD) is a rare inherited genetic disorder. There have been 34 subtypes of ALD described. X-linked ALD is the most common category. ALD results in degeneration of:
There are six subtypes of X-linked ALD:
ALD is caused by an inherited defective gene.
In people with ALD, the body cannot properly break down fatty acids. This results in a build up of saturated fatty acids in the brain and the adrenal cortex. This causes damage of the myelin sheath in the brain and the adrenal gland.
Factors that increase your chance for X-linked ALD include:
Symptoms can vary within the types of ALD.
This form is the most severe. It only affects boys. Symptoms usually begin between 2–10 years of age. About 35% of patients can have severe symptoms during the early phase. On average, death results in two years. Some patients may live a couple of decades.
Initial symptoms include:
As the disease progresses, more serious symptoms develop. These include:
This type is similar to the childhood type. In this type it begins around 11-21 years of age. The progression is usually slower.
This is the most common form. Symptoms of AMN can present in the 20s. It progresses slowly. They can include:
With this type, symptoms usually do not appear until young adulthood (20s) or middle age (50s). It causes symptoms similar to schizophrenia and dementia. It usually progresses quickly. Death or a vegetative state can occur in 3-4 years.
This form is only seen in women. Symptoms may be mild or severe. It usually does not affect the adrenal gland function.
The doctor will ask about symptoms and medical history. A physical exam will be done. The doctor may suspect ALD from its symptoms. To confirm the diagnosis your doctor may order:
There is no known cure for the brain damage of ALD. However, the adrenal deficiency can be treated with cortisone replacement. ALD often causes death within 10 years of the onset of symptoms.
Some therapies can help to manage the symptoms of ALD. There are also some experimental treatments.
Therapies to help manage the symptoms of ALD include:
Some treatments that are still be investigated that you may want to talk to your doctor about include:
There is no way to prevent ALD. If you have ALD or have a family history of the disorder, you can talk to a genetic counselor when deciding to have children.
Early recognition and treatment may prevent the development of clinical symptoms. This is especially true in young boys who are treated with Lorenzo’s oil. New technologies may soon allow early identification through newborn screening.
National Institute of Neurological Disorders and Stroke
National Organization for Rare Disorders
United Leukodystrophy Foundation
Canadian Directory of Genetic Support Groups
The Myelin Project of Canada
Berger J, Pujol A, Aubourg P, Forrs-Petter S. Current and future pharmacologic treatment strategies in X-linked adrenoleukodystrophy. Brain Pathol . 2010;20(4):845-856.
Moser HW. Therapy of X-linked adrenoleukodystrophy (review). NeuroRx. 2006 . Apr;3(2):246-53.
Moser HW, Raymond GV, Dubey P. Adrenoleukodystrophy: new approaches to a neurodegenerative disease. JAMA . 2005 Dec 28;294(24):3131-4.
Moser HW, Raymond GV, Lu SE, Muenz LR, Moser AB, Xu J, et al. Follow-up of 89 asymptomatic patients with adrenoleukodystrophy treated with Lorenzo's oil. Arch Neurol . 2005 Jul;62(7):1073-1080.
Adrenoleukodystrophy. National Institute of Neurological Disorders and Stroke website. Available at: http://www.ninds.n... . Accessed September 8, 2012.
Last reviewed September 2012 by Rimas Lukas, MD
Last Updated: 09/30/2012
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