Refsum disease

General Information (adopted from Orphanet):

Synonyms, Signs: HMSN 4
Hereditary motor and sensory neuropathy type 4
Heredopathia atactica polyneuritiformis
Phytanic acid oxidase deficiency
Number of Symptoms 55
OrphanetNr: 773
OMIM Id: 266500
614879
ICD-10: G60.1
UMLs: C0034960
MeSH: D012035
MedDRA: 10038275
Snomed: 25362006

Prevalence, inheritance and age of onset:

Prevalence: 0.1 of 100 000 [Orphanet]
Inheritance: Autosomal recessive
[Orphanet]
Age of onset: Infancy
Childhood
Adolescent
Adult
[Orphanet]

Disease classification (adopted from Orphanet):

Parent Diseases: Autosomal ichthyosis syndrome with prominent neurologics signs
 -Rare genetic disease
 -Rare skin disease
Autosomal recessive metabolic cerebellar ataxia
 -Rare eye disease
 -Rare genetic disease
 -Rare neurologic disease
Cataract associated with a metabolic disease
 -Rare eye disease
 -Rare genetic disease
Disorder of peroxisomal alpha-, beta- and omega-oxidation
 -Rare genetic disease
Leukodystrophy
 -Rare genetic disease
 -Rare neurologic disease
Metabolic disease with pigmentary retinitis
 -Rare eye disease
 -Rare genetic disease
Neurometabolic disease
 -Rare genetic disease
 -Rare neurologic disease
Rare hereditary metabolic disease with peripheral neuropathy
 -Rare genetic disease
 -Rare neurologic disease
Syndromic ichthyosis associated with ocular features
 -Rare eye disease
 -Rare genetic disease

Symptom Information: Sort by abundance 

1
(HPO:0012211) Abnormal renal physiology rare [HPO:skoehler] 23 / 7739
2
(HPO:0000083) Renal insufficiency Occasional [Orphanet] 232 / 7739
3
(HPO:0000458) Anosmia 49 / 7739
4
(HPO:0004408) Abnormality of the sense of smell Very frequent [Orphanet] 28 / 7739
5
(HPO:0000518) Cataract Very frequent [Orphanet] 454 / 7739
6
(HPO:0008056) Aplasia/Hypoplasia affecting the eye Occasional [Orphanet] 142 / 7739
7
(HPO:0000572) Visual loss Occasional [Orphanet] 272 / 7739
8
(HPO:0000488) Retinopathy Very frequent [Orphanet] 75 / 7739
9
(HPO:0000478) Abnormality of the eye Very frequent [Orphanet] 126 / 7739
10
(HPO:0000662) Nyctalopia 92 / 7739
11
(HPO:0000508) Ptosis Frequent [Orphanet] 459 / 7739
12
(HPO:0000546) Retinal degeneration 61 / 7739
13
(HPO:0000616) Miosis 11 / 7739
14
(HPO:0000510) Rod-cone dystrophy Very frequent [Orphanet] 266 / 7739
15
(HPO:0000615) Abnormality of the pupil Frequent [Orphanet] 39 / 7739
16
(HPO:0000639) Nystagmus Occasional [Orphanet] 555 / 7739
17
(HPO:0000496) Abnormality of eye movement Frequent [Orphanet] 79 / 7739
18
(HPO:0000407) Sensorineural hearing impairment Very frequent [Orphanet] 524 / 7739
19
(HPO:0000598) Abnormality of the ear Very frequent [Orphanet] 98 / 7739
20
(HPO:0009830) Peripheral neuropathy Very frequent [Orphanet] 206 / 7739
21
(HPO:0003474) Sensory impairment 54 / 7739
22
(HPO:0004374) Hemiplegia/hemiparesis Very frequent [Orphanet] 158 / 7739
23
(HPO:0001265) Hyporeflexia 208 / 7739
24
(HPO:0002066) Gait ataxia Very frequent [Orphanet] 327 / 7739
25
(HPO:0100543) Cognitive impairment Frequent [Orphanet] 230 / 7739
26
(HPO:0002167) Neurological speech impairment Very frequent [Orphanet] 308 / 7739
27
(HPO:0002922) Increased CSF protein 27 / 7739
28
(HPO:0007141) Sensorimotor neuropathy 27 / 7739
29
(HPO:0007256) Abnormal pyramidal signs Very frequent [Orphanet] 116 / 7739
30
(HPO:0001251) Ataxia 413 / 7739
31
(HPO:0002652) Skeletal dysplasia Very frequent [Orphanet] 113 / 7739
32
(HPO:0001163) Abnormality of the metacarpal bones Frequent [Orphanet] 149 / 7739
33
(HPO:0005930) Abnormality of epiphysis morphology Frequent [Orphanet] 119 / 7739
34
(HPO:0004689) Short fourth metatarsal 9 / 7739
35
(HPO:0002654) Multiple epiphyseal dysplasia 8 / 7739
36
(HPO:0010161) Abnormality of the phalanges of the toes Frequent [Orphanet] 3 / 7739
37
(HPO:0001760) Abnormality of the foot Very frequent [Orphanet] 96 / 7739
38
(HPO:0001761) Pes cavus Occasional [Orphanet] 225 / 7739
39
(HPO:0001744) Splenomegaly Frequent [Orphanet] 337 / 7739
40
(HPO:0006568) Increased hepatic glycogen content Frequent [Orphanet] 34 / 7739
41
(HPO:0008064) Ichthyosis Very frequent [Orphanet] 108 / 7739
42
(HPO:0000958) Dry skin Very frequent [Orphanet] 152 / 7739
43
(HPO:0011675) Arrhythmia 226 / 7739
44
(HPO:0001640) Cardiomegaly 81 / 7739
45
(HPO:0001638) Cardiomyopathy Very frequent [Orphanet] 192 / 7739
46
(HPO:0001635) Congestive heart failure 232 / 7739
47
(HPO:0011025) Abnormality of cardiovascular system physiology Occasional [Orphanet] 41 / 7739
48
(HPO:0010571) Elevated levels of phytanic acid 3 / 7739
49
(HPO:0001939) Abnormality of metabolism/homeostasis Very frequent [Orphanet] 328 / 7739
50
(HPO:0002093) Respiratory insufficiency Occasional [Orphanet] 410 / 7739
51
(HPO:0003202) Skeletal muscle atrophy Frequent [Orphanet] 281 / 7739
52
(HPO:0003690) Limb muscle weakness 41 / 7739
53
(HPO:0001252) Muscular hypotonia Frequent [Orphanet] 990 / 7739
54
(HPO:0012758) Neurodevelopmental delay Frequent [Orphanet] 949 / 7739
55
(HPO:0000007) Autosomal recessive inheritance 2538 / 7739

Associated genes:

ClinVar (via SNiPA)

Gene symbol Variation Clinical significance Reference

Additional Information:

Diagnosis GeneReviews Refsum disease, also referred to as "classic Refsum disease" (CRD) or "adult Refsum disease" (ARD), is suspected in individuals with late childhood-onset retinitis pigmentosa and variable combinations (in decreasing order of frequency) of the following: ...
Clinical Description GeneReviews Onset of symptoms in "classic Refsum disease" (CRD) or "adult Refsum disease" (ARD) ranges from age seven months to after age 50 years. However, because the onset is insidious, it is difficult for many individuals to know exactly when symptoms first started. A few individuals remain asymptomatic until adulthood [Skjeldal et al 1987]. Early-onset disease is not necessarily associated with a poor prognosis for life span. ...
Genotype-Phenotype Correlations GeneReviews More studies are needed to determine if Refsum disease caused by mutations in PHYH and Refsum disease caused by mutations in PEX7 are phenotypically different. The Refsum disease phenotype caused by mutations in PEX7 may be milder [van den Brink et al 2003b], as exemplified by the patient described by Horn et al [2007]....
Differential Diagnosis GeneReviews Phytanic acid is also elevated in other peroxisomal disorders including: ...
Management GeneReviews To establish the extent of disease in an individual diagnosed with Refsum disease, the following evaluations are recommended:...
Molecular genetics GeneReviews Information in the Molecular Genetics and OMIM tables may differ from that elsewhere in the GeneReview: tables may contain more recent information. —ED....