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Hypouricemia is not a medical condition itself (i.e., it is benign), but it is a useful medical sign. Usually hypouricemia is due to drugs and toxic agents, sometimes it is due to diet or genetics, and rarely it is due to an underlying medical condition. When one of these causal medical conditions is present, hypouricemia is a common sign.
Hypouricemia is a level of uric acid in blood serum that is below normal. In humans, the normal range of this blood component has a lower threshold set variously in the range of 2 mg/dL to 4 mg/dL, while the upper threshold is 530 micromol/L (6 mg/dL) for women and 619 micromol/L (7 mg/dL) for men. Hypouricemia usually is benign and sometimes is a sign of a medical condition.
Increased levels predispose for gout and, if very high, kidney failure. The metabolic syndrome often presents with hyperuricemia. Prognosis is good with regular consumption of Allopurinol.
People with gout, and by inference hyperuricemia, are significantly less likely to develop Parkinson's disease, unless they also require diuretics.
A purine-rich diet is a common but minor cause of hyperuricemia. Diet alone generally is not sufficient to cause hyperuricemia. Purine content of foods varies (see Gout). Foods high in the purines adenine and hypoxanthine may be more potent in exacerbating hyperuricemia.
Hyperuricemia of this type is a common complication of solid organ transplant. Apart from normal variation (with a genetic component), tumor lysis syndrome produces extreme levels of uric acid, mainly leading to renal failure. The Lesch-Nyhan syndrome is also associated with extremely high levels of uric acid.
Haemochromatosis is in its manifestations, "i.e.", often presenting with signs or symptoms suggestive of other diagnoses that affect specific organ systems. Many of the signs and symptoms below are uncommon and most patients with the hereditary form of haemochromatosis do not show any overt signs of disease nor do they suffer premature morbidity.
The classic triad of cirrhosis, bronze skin and diabetes is not as common any more because of earlier diagnosis.
The more common clinical manifestations include:
- Fatigue
- Malaise
- Joint and bone pain
- Liver cirrhosis (with an increased risk of hepatocellular carcinoma) Liver disease is always preceded by evidence of liver dysfunction including elevated serum enzymes specific to the liver, clubbing of the fingers, leuconychia, asterixis, hepatomegaly, palmar erythema and spider naevi. Cirrhosis can also present with jaundice (yellowing of the skin) and ascites.
- Insulin resistance (often patients have already been diagnosed with diabetes mellitus type 2) due to pancreatic damage from iron deposition
- Erectile dysfunction and hypogonadism, resulting in decreased libido
- Congestive heart failure, abnormal heart rhythms or pericarditis
- Arthritis of the hands (especially the second and third MCP joints), but also the knee and shoulder joints
- Damage to the adrenal gland, leading to adrenal insufficiency
Less common findings including:
- Deafness
- Dyskinesias, including Parkinsonian symptoms
- Dysfunction of certain endocrine organs:
- Parathyroid gland (leading to hypocalcaemia)
- Pituitary gland
- More commonly a slate-grey or less commonly darkish colour to the skin (see pigmentation, hence its name "diabetes bronze" when it was first described by Armand Trousseau in 1865)
- An increased susceptibility to certain infectious diseases caused by siderophilic microorganisms:
- "Vibrio vulnificus" infections from eating seafood or wound infection
- "Listeria monocytogenes"
- "Yersinia enterocolica"
- "Salmonella enterica" (serotype Typhymurium)
- "Klebsiella pneumoniae"
- "Escherichia coli"
- "Rhizopus arrhizus"
- "Mucor" species
Males are usually diagnosed after their forties and fifties, and women several decades later, owing to regular iron loss through menstruation (which ceases in menopause). The severity of clinical disease in the hereditary form varies considerably. There is evidence suggesting that hereditary haemochromatosis patients affected with other liver ailments such as hepatitis or alcoholic liver disease suffer worse liver disease than those with either condition alone. There are also juvenile forms of hereditary haemochromatosis that present in childhood with the same consequences of iron overload.
At times, there are no symptoms of this disease, but when they do occur they are widely varied and can occur rapidly or gradually. When caused by an allergic reaction, the symptoms of acute tubulointerstitial nephritis are fever (27% of patients), rash (15% of patients), and enlarged kidneys. Some people experience dysuria, and lower back pain. In chronic tubulointerstitial nephritis the patient can experience symptoms such as nausea, vomiting, fatigue, and weight loss. Other conditions that may develop include hyperkalemia, metabolic acidosis, and kidney failure.
Interstitial nephritis (or tubulo-interstitial nephritis) is a form of nephritis affecting the interstitium of the kidneys surrounding the tubules, i.e., is inflammation of the spaces between renal tubules. This disease can be either acute, meaning it occurs suddenly, or chronic, meaning it is ongoing and eventually ends in kidney failure.
Iron is stored in the liver, the pancreas and the heart. Long-term effects of haemochromatosis on these organs can be very serious, even fatal when untreated. For example, similar to alcoholism, haemochromatosis can cause cirrhosis of the liver. The liver is a primary storage area for iron and will naturally accumulate excess iron. Over time the liver is likely to be damaged by iron overload. Cirrhosis itself may lead to additional and more serious complications, including bleeding from dilated veins in the esophagus (esophageal varices) and stomach (gastric varices) and severe fluid retention in the abdomen (ascites). Toxins may accumulate in the blood and eventually affect mental functioning. This can lead to confusion or even coma (hepatic encephalopathy).
Liver cancer: Cirrhosis and haemochromatosis together will increase the risk of liver cancer. (Nearly one-third of people with haemochromatosis and cirrhosis eventually develop liver cancer.)
Diabetes: The pancreas which also stores iron is very important in the body’s mechanisms for sugar metabolism. Diabetes affects the way the body uses blood sugar (glucose). Diabetes is in turn the leading cause of new blindness in adults and may be involved in kidney failure and cardiovascular disease.
Congestive heart failure: If excess iron in the heart interferes with the its ability to circulate enough blood, a number of problems can occur, even death. The condition may be reversible when haemochromatosis is treated and excess iron stores reduced.
Heart arrhythmias: Arrhythmia or abnormal heart rhythms can cause heart palpitations, chest pain and light-headedness and are occasionally life-threatening. This condition can often be reversed with treatment for haemochromatosis.
Pigment changes: Bronze or grey coloration of the skin is caused primarily by increased melanin deposition, with iron deposition playing a lesser role.
Meleda disease (MDM) or "mal de Meleda", also called Mljet disease, keratosis palmoplantaris and transgradiens of Siemens, (also known as "Acral keratoderma," "Mutilating palmoplantar keratoderma of the Gamborg-Nielsen type," "Palmoplantar ectodermal dysplasia type VIII", and "Palmoplantar keratoderma of the Norrbotten type") is an extremely rare autosomal recessive congenital skin disorder in which dry, thick patches of skin develop on the soles of the hands and feet, a condition known as palmoplantar hyperkeratosis.
MDM is most common on the Dalmatian island of Mljet (or "Meleda"), thought to be because of a founder effect. It is of autosomal recessive inheritance. It may be caused by a mutation on the "SLURP1" gene, located on chromosome 8.
The demyelinating diseases of the peripheral nervous system include:
- Guillain–Barré syndrome and its chronic counterpart, chronic inflammatory demyelinating polyneuropathy
- Anti-MAG peripheral neuropathy
- Charcot–Marie–Tooth disease and its counterpart Hereditary neuropathy with liability to pressure palsy
- Copper deficiency associated conditions (peripheral neuropathy, myelopathy, and rarely optic neuropathy)
- Progressive inflammatory neuropathy
The demyelinating disorders of the central nervous system include:
- Myelinoclastic disorders, in which myelin is attacked by external substances
- standard multiple sclerosis, Devic's disease and other disorders with immune system involvement called inflammatory demyelinating diseases.
- Leukodystrophic disorders, in which myelin is not properly produced:
- CNS neuropathies like those produced by vitamin B12 deficiency
- Central pontine myelinolysis
- Myelopathies like tabes dorsalis (syphilitic myelopathy)
- leukoencephalopathies like progressive multifocal leukoencephalopathy
- Leukodystrophies
These disorders are normally associated also with the conditions optic neuritis and transverse myelitis, which are inflammatory conditions, because inflammation and demyelination are frequently associated. Some of them are idiopathic and for some others the cause has been found, like some cases of neuromyelitis optica.
This disease in humans is usually caused by "Demodex folliculorum" (not the same species affecting dogs) and is usually called demodicosis which may have a rosacea-like appearance. Common symptoms include hair loss, itching and inflammation. An association with pityriasis folliculorum has also been described.
Demodicosis is most often seen in folliculitis (inflammation of the hair follicles of the skin). Depending on the location it may be a small pustules (pimples or pustules) at the exit of hair, placed on inflamed, congested skin. Demodicosis is accompanied by itching, swelling and erythema of the eyelid margins, the appearance of scales at the base of the eyelashes. Typically, patients complain of eyestrain. Characteristic of view of the affected century: plaque on the edge of the eyelids, eyelashes stuck together, surrounded by crusts as a clutch.
Demodicosis, also called demodectic mange or red mange, is caused by a sensitivity to and overpopulation of "Demodex canis" as the hosts immune system is unable to keep the mites under control.
"Demodex" is a genus of mite in the family Demodicidae. "Demodex canis" occurs naturally in the hair follicles of most dogs in low numbers around the face and other areas of the body. In most dogs, these mites never cause problems. However, in certain situations, such as an underdeveloped or impaired immune system, intense stress, or malnutrition, the mites can reproduce rapidly, causing symptoms in sensitive dogs that range from mild irritation and hair loss on a small patch of skin to severe and widespread inflammation, secondary infection, and in rare cases can be a life-threatening condition. Small patches of demodicosis often correct themselves over time as the dog's immune system matures, although treatment is usually recommended.