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Evaluation of patients with an abnormal newborn screen showing elevations of 3-hydroxyisovaleryl-/2-methyl-3-hydroxy acylcarnitine (C5-OH)
Evaluation of patients with an abnormal newborn screen showing elevations of C5-OH. The results are not informative when patient is receiving L-carnitine supplements.
The differential diagnosis of an isolated elevation of 3-hydroxyisovaleryl-/2-methyl-3-hydroxy acylcarnitine (C5-OH) in plasma or (newborn screening) blood spots includes the following disorders:
-3-Methylcrotonyl-CoA carboxylase deficiency (common name: 3-methylcrotonylglycinuria), either infantile or maternal
-3-Hydroxy 3-methylglutaryl-(HMG)-CoA lyase deficiency
-2-Methyl 3-hydroxybutyryl-CoA dehydrogenase deficiency, 3-methylglutaconic aciduria type I, and biotinidase deficiency or holocarboxylase deficiency
Confirmatory and diagnostic testing are necessary to differentiate these clinical entities. This test can be useful in differentiating patients with 3-methylcrotonylglycinuria and with 3-methylglutaconic aciduria as they typically excrete larger amounts of C5-OH in urine compared to patients with the other diagnoses.
The American College of Medical Genetics (ACMG) newborn screening work group published diagnostic algorithms for the follow-up of infants who had positive newborn screening results. For more information, see URL: http://www.acmg.net.
<2.93 millimoles/mole creatinine
Preliminary data showed that an elevated excretion in urine and concentration in plasma of 3-hydroxyisovaleryl-/2-methyl-3-hydroxy acylcarnitine (C5-OH) can be the only biochemical abnormalities in patients with 3-methylcrotonylglycinuria.
Contact Mayo Medical Laboratories for assistance in test interpretation and additional testing options.
The results of urine acylcarnitines are not informative when the patient is receiving L-carnitine supplements.
Wolfe LA, Finegold DN, Vockley J, et al: Potential misdiagnosis of 3-methylcrotonyl-coenzyme A carboxylase deficiency associated with absent or trace urinary 3-methylcrotonylglycine. Pediatrics 2007 Nov;120(5):e1335-1340