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    Hurler syndrome

    Alpha-L-iduronate deficiency; Mucopolysaccharidosis type I; MPS I H

    Hurler syndrome is a rare, inherited disease of metabolism in which a person cannot break down long chains of sugar molecules called glycosaminoglycans (formerly called mucopolysaccharides).

    Hurler syndrome belongs to a group of diseases called mucopolysaccharidoses, or MPS.

    See also:

    • MPS II (Hunter syndrome)
    • MPS IV (Morquio syndrome)
    • MPS III (Sanfilippo syndrome)
    • MPS I S (Scheie syndrome)

    Causes

    Persons with Hurler syndrome do not make a substance called lysosomal alpha-L-iduronidase. This substance, called an enzyme, helps break down long chains of sugar molecules called glycosaminoglycans (formerly called mucopolysaccharides). These molecules are found throughout the body, often in mucus and in fluid around the joints.

    Without the enzyme, glycosaminoglycans build up and damage organs, including the heart. Symptoms can range from mild to severe.

    Hurler syndrome is inherited, which means that your parents must pass the disease on to you. If both parents carry the defective gene related to this condition, each of their children has a 25% chance of developing the disease.

    Hurler syndrome is a type of mucopolysaccharidosis called MPS I. Hurler syndrome is the most severe type. It is categorized as MPS I H.

    The other subtypes of MPS I are:

    • MPS I H-S (Hurler-Scheie syndrome)
    • MPS I S (Scheie syndrome)

    Symptoms

    Symptoms of Hurler syndrome most often appear between ages 3 and 8. Infants with severe Hurler syndrome appear normal at birth. Facial symptoms may become more noticeable during the first 2 years of life.

    Symptoms include:

    • Abnormal bones in the spine
    • Claw hand
    • Cloudy corneas
    • Deafness
    • Halted growth
    • Heart valve problems
    • Joint disease, including stiffness
    • Intellectual disability that gets worse over time
    • Thick, coarse facial features with low nasal bridge

    Exams and Tests

    • EKG
    • Genetic testing forchanges (mutations) to the alpha-L-iduronidase (IDUA) gene
    • Urine tests for extra mucopolysaccharides
    • X-ray of the spine

    Treatment

    Enzyme replacement therapy for Hurler syndrome adds a working form of the missing enzyme to the body.The medication, called laronidase (Aldurazyme), is given through a vein (intravenously). Talk to your doctor for more information.

    Bone marrow transplant has been used in several patients with this condition. The treatment has had mixed results.

    Other treatments depend on the organs that are affected.

    Support Groups

    For more information and support, contact one of the following organizations:

    Outlook (Prognosis)

    Hurler syndrome is a disease with a poor outlook. Children with this disease develop nervous system problems, and can die young.

    When to Contact a Medical Professional

    Call your health care provider if:

    • You have a family history of Hurler syndrome and are considering having children
    • Your child begins to show symptoms of Hurler syndrome

    Prevention

    Experts recommend genetic counseling and testing for couples with a family history of Hurler syndrome who are considering having children. Prenatal testing is available.

    References

    Staba SL, Escolar ML, Poe M, et al. Cord-blood transplants from unrelated donors in patients with Hurler's syndrome. N Engl J Med. 2004 May 6;350(19):1960-9.

    National Institute of Neurological Disorders and Stroke. Mucolipidoses Fact Sheet. Office of Communications and Public Liaison. Bethesda, MD; Publication No. 03-5115. February 13, 2007.

    Wraith JE. Mucopolysaccharidoses and oligosaccharidoses. In: Saudubray JM, van den Berghe G, Walter JH, eds. Inborn Metabolic Diseases: Diagnosis and Treatment. 5th ed. New York, NY: Springer; 2012:chap 40.

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    • Low nasal bridge

      illustration

      • Low nasal bridge

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      A Closer Look

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          Tests for Hurler syndrome

            Review Date: 5/7/2013

            Reviewed By: Chad Haldeman-Englert, MD, FACMG, Wake Forest School of Medicine, Department of Pediatrics, Section on Medical Genetics, Winston-Salem, NC. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Bethanne Black, and the A.D.A.M. Editorial team.

            The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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