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(ALD; Sudanophilic Leukodystrophy; Schilder’s Disease)
by Rick Alan
X-linked adrenoleukodystrophy (ALD) is a rare inherited genetic disorder. There are 40 subtypes of leukodystrophy. X-linked ALD is the most common category. ALD results in degeneration of the:
There are 6 subtypes of X-linked ALD:
Adrenoleukodystrophy (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 to the myelin sheath in the brain and adrenal gland.
Risk Factors TOP
This condition is most common in males, although females may also be affected. It is also more common in children and young adults. Having a mother who carries the defective X-linked adrenoleukodystrophy (ALD) gene may increase your risk.
Symptoms can vary within the types of ALD.
X-linked ALD (Childhood Cerebral ALD)
This form is the most severe. It only affects boys. Symptoms usually begin between 2–10 years of age. About 35% of boys can have severe symptoms during the early phase. On average, death results in 2 years, though some may live a couple of decades.
Initial symptoms include:
As the disease progresses, more serious symptoms develop. These include:
X-linked ALD (Adolescent Cerebral ALD)
This type is similar to the childhood type. It begins around 11-21 years of age. The progression is usually slower.
Adrenomyeloneuropathy (AMN) TOP
This is the most common form. Symptoms of AMN can present in the 20's. It progresses slowly. Symptoms can include:
X-linked ALD (Adult Cerebral ALD) TOP
With this type, symptoms usually do not appear until young adulthood (20's) or middle age (50's). It causes symptoms similar to schizophrenia and dementia. It usually progresses quickly. Death or a vegetative state can occur in 3-4 years.
Symptomatic Heterozygotes TOP
This form is only seen in women. Symptoms may be mild or severe. It usually does not affect the adrenal gland function.
You will be asked about your symptoms and medical history. A physical exam will be done.
Your bodily fluids may be tested. This can be done with:
Images may be taken of your brain. This can be done with an MRI scan.
There is no known cure for the brain damage of adrenoleukodystrophy (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 manage the symptoms of ALD. These include:
There are also some experimental treatments. Some treatments that are still being investigated that you may want to talk to your doctor about include:
There is no known 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 symptoms from developing. New technologies may soon allow early identification through newborn screening.
National Institute of Neurological Disorders and Stroke
United Leukodystrophy Foundation
The Myelin Project of Canada
Berger J, Pujol A, et al. Current and future pharmacologic treatment strategies in X-linked adrenoleukodystrophy. Brain Pathol. 2010;20(4):845-856.
Moser HW. Therapy of X-linked adrenoleukodystrophy. NeuroRx. 2006;3(2):246-253.
Moser HW, Raymond GV, et al. Adrenoleukodystrophy: new approaches to a neurodegenerative disease. JAMA. 2005;294(24):3131-3134.
Moser HW, Raymond GV, et al. Follow-up of 89 asymptomatic patients with adrenoleukodystrophy treated with Lorenzo's oil. Arch Neurol. 2005;62(7):1073-1080.
NINDS adrenoleukodystrophy information page. National Institute of Neurological Disorders and Stroke website. Available at:
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Updated March 31, 2016. Accessed June 6, 2016.
Last reviewed June 2016 by Kari Kassir, MD
Last Updated: 6/3/2014
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