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Genetics Home Reference: your guide to understanding genetic conditions
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Tyrosinemia

Reviewed January 2008

What is tyrosinemia?

Tyrosinemia is a genetic disorder characterized by elevated blood levels of the amino acid tyrosine, a building block of most proteins. Tyrosinemia is caused by the shortage (deficiency) of one of the enzymes required for the multistep process that breaks down tyrosine. If untreated, tyrosine and its byproducts build up in tissues and organs, which leads to serious medical problems.

There are three types of tyrosinemia. Each has distinctive symptoms and is caused by the deficiency of a different enzyme. Type I tyrosinemia, the most severe form of this disorder, is caused by a shortage of the enzyme fumarylacetoacetate hydrolase. Symptoms usually appear in the first few months of life and include failure to gain weight and grow at the expected rate (failure to thrive), diarrhea, vomiting, yellowing of the skin and whites of the eyes (jaundice), cabbage-like odor, and increased tendency to bleed (particularly nosebleeds). Type I tyrosinemia can lead to liver and kidney failure, problems affecting the nervous system, and an increased risk of liver cancer.

Type II tyrosinemia is caused by a deficiency of the enzyme tyrosine aminotransferase. This form of the disorder can affect the eyes, skin, and mental development. Symptoms often begin in early childhood and include excessive tearing, abnormal sensitivity to light (photophobia), eye pain and redness, and painful skin lesions on the palms and soles. About 50 percent of individuals with type II tyrosinemia have some degree of intellectual disability.

Type III tyrosinemia is a rare disorder caused by a deficiency of the enzyme 4-hydroxyphenylpyruvate dioxygenase. Characteristic features include intellectual disability, seizures, and periodic loss of balance and coordination (intermittent ataxia).

About 10 percent of newborns have temporarily elevated levels of tyrosine. In these cases, the cause is not genetic. The most likely causes are vitamin C deficiency or immature liver enzymes due to premature birth.

How common is tyrosinemia?

Worldwide, type I tyrosinemia affects about 1 person in 100,000. This type of tyrosinemia is much more common in Quebec, Canada. The overall incidence in Quebec is about 1 in 16,000 individuals. In the Saguenay-Lac St. Jean region of Quebec, type I tyrosinemia affects 1 person in 1,846.

Type II tyrosinemia occurs in fewer than 1 in 250,000 individuals. Type III tyrosinemia is very rare; only a few cases have been reported.

What genes are related to tyrosinemia?

Mutations in the FAH, HPD, and TAT genes cause tyrosinemia.

In the liver, enzymes break down tyrosine in a five-step process into harmless molecules that are either excreted by the kidneys or used in reactions that produce energy. Mutations in the FAH, HPD, or TAT gene cause a shortage of one of the enzymes in this multistep process. The resulting enzyme deficiency leads to a toxic accumulation of tyrosine and its byproducts, which can damage the liver, kidneys, nervous system, and other organs and tissues.

Related Gene(s)

Changes in these genes are associated with tyrosinemia.

  • FAH
  • HPD
  • TAT

How do people inherit tyrosinemia?

This condition is inherited in an autosomal recessive pattern, which means both copies of the gene in each cell have mutations. The parents of an individual with an autosomal recessive condition each carry one copy of the mutated gene, but they typically do not show signs and symptoms of the condition.

Where can I find information about diagnosis or management of tyrosinemia?

These resources address the diagnosis or management of tyrosinemia and may include treatment providers.

  • Baby's First Test: Tyrosinemia, Type I (http://www.babysfirsttest.org/newborn-screening/conditions/tyrosinemia-type-i)
  • Baby's First Test: Tyrosinemia, Type II (http://www.babysfirsttest.org/newborn-screening/conditions/tyrosinemia-type-ii)
  • Baby's First Test: Tyrosinemia, Type III (http://www.babysfirsttest.org/newborn-screening/conditions/tyrosinemia-type-iii)
  • Gene Review: Tyrosinemia Type I (http://www.ncbi.nlm.nih.gov/books/NBK1515/)
  • Genetic Testing Registry: 4-Hydroxyphenylpyruvate dioxygenase deficiency (http://www.ncbi.nlm.nih.gov/gtr/conditions/C0268623)
  • Genetic Testing Registry: Tyrosinemia type 2 (http://www.ncbi.nlm.nih.gov/gtr/conditions/C0268487)
  • Genetic Testing Registry: Tyrosinemia type I (http://www.ncbi.nlm.nih.gov/gtr/conditions/C0268490)

You might also find information on the diagnosis or management of tyrosinemia in Educational resources (http://www.ghr.nlm.nih.gov/condition/tyrosinemia/show/Educational+resources) and Patient support (http://www.ghr.nlm.nih.gov/condition/tyrosinemia/show/Patient+support).

General information about the diagnosis (http://ghr.nlm.nih.gov/handbook/consult/diagnosis) and management (http://ghr.nlm.nih.gov/handbook/consult/treatment) of genetic conditions is available in the Handbook. Read more about genetic testing (http://ghr.nlm.nih.gov/handbook/testing), particularly the difference between clinical tests and research tests (http://ghr.nlm.nih.gov/handbook/testing/researchtesting).

To locate a healthcare provider, see How can I find a genetics professional in my area? (http://ghr.nlm.nih.gov/handbook/consult/findingprofessional) in the Handbook.

Where can I find additional information about tyrosinemia?

You may find the following resources about tyrosinemia helpful. These materials are written for the general public.

You may also be interested in these resources, which are designed for healthcare professionals and researchers.

What other names do people use for tyrosinemia?

  • Hereditary Tyrosinemias
  • Hypertyrosinemia

For more information about naming genetic conditions, see the Genetics Home Reference Condition Naming Guidelines (http://ghr.nlm.nih.gov/ConditionNameGuide) and How are genetic conditions and genes named? (http://ghr.nlm.nih.gov/handbook/mutationsanddisorders/naming) in the Handbook.

What if I still have specific questions about tyrosinemia?

Ask the Genetic and Rare Diseases Information Center (http://rarediseases.info.nih.gov/GARD/).

What glossary definitions help with understanding tyrosinemia?

amino acid ; ataxia ; autosomal ; autosomal recessive ; cancer ; cell ; congenital ; deficiency ; disability ; enzyme ; failure to thrive ; gene ; hereditary ; hydrolase ; incidence ; inherited ; jaundice ; keratosis ; kidney ; liver cancer ; nervous system ; newborn screening ; photophobia ; recessive ; screening ; sensitivity ; syndrome ; toxic ; transient ; Tyr ; tyrosine

You may find definitions for these and many other terms in the Genetics Home Reference Glossary (http://www.ghr.nlm.nih.gov/glossary).

References

  • Ellaway CJ, Holme E, Standing S, Preece MA, Green A, Ploechl E, Ugarte M, Trefz FK, Leonard JV. Outcome of tyrosinaemia type III. J Inherit Metab Dis. 2001 Dec;24(8):824-32. (http://www.ncbi.nlm.nih.gov/pubmed/11916315?dopt=Abstract)
  • Grompe M. The pathophysiology and treatment of hereditary tyrosinemia type 1. Semin Liver Dis. 2001 Nov;21(4):563-71. Review. (http://www.ncbi.nlm.nih.gov/pubmed/11745044?dopt=Abstract)
  • Macsai MS, Schwartz TL, Hinkle D, Hummel MB, Mulhern MG, Rootman D. Tyrosinemia type II: nine cases of ocular signs and symptoms. Am J Ophthalmol. 2001 Oct;132(4):522-7. (http://www.ncbi.nlm.nih.gov/pubmed/11589874?dopt=Abstract)
  • Russo PA, Mitchell GA, Tanguay RM. Tyrosinemia: a review. Pediatr Dev Pathol. 2001 May-Jun;4(3):212-21. Review. (http://www.ncbi.nlm.nih.gov/pubmed/11370259?dopt=Abstract)

 

The resources on this site should not be used as a substitute for professional medical care or advice. Users seeking information about a personal genetic disease, syndrome, or condition should consult with a qualified healthcare professional. See How can I find a genetics professional in my area? (http://ghr.nlm.nih.gov/handbook/consult/findingprofessional) in the Handbook.

 
Reviewed: January 2008
Published: July 21, 2014