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Encyclopedia > Wilson's disease
Wilson's disease
Classification & external resources
ICD-10 E83.0
ICD-9 275.1
OMIM 277900
DiseasesDB 14152
MedlinePlus 000785
eMedicine med/2413  neuro/570 ped/2441

Wilson's disease or hepatolenticular degeneration is an autosomal recessive hereditary disease, with an incidence of about 1 in 30,000 in most parts of the world and a male preponderance. Its main feature is accumulation of copper in tissues, which manifests itself with neurological symptoms and liver disease. The estimated heterozygous carrier rate is about 1 in 100, meaning that 1 in 100 people are unaffected carriers of this mutation. The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The International Statistical Classification of Diseases and Related Health Problems 10th Revision (ICD-10) is a coding of diseases and signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO). ... // E00-E35 - Endocrine diseases (E00-E07) Disorders of thyroid gland (E00) Congenital iodine-deficiency syndrome (E01) Iodine-deficiency-related thyroid disorders and allied conditions (E02) Subclinical iodine-deficiency hypothyroidism (E03) Other hypothyroidism (E030) Congenital hypothyroidism with diffuse goitre (E031) Congenital hypothyroidism without goitre (E032) Hypothyroidism due to medicaments and other... The International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD) provides codes to classify diseases and a wide variety of signs, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or disease. ... The following is a list of codes for International Statistical Classification of Diseases and Related Health Problems. ... The Mendelian Inheritance in Man project is a database that catalogues all the known diseases with a genetic component, and - when possible - links them to the relevant genes in the human genome. ... The Disease Bold textDatabase is a free website that provides information about the relationships between medical conditions, symptoms, and medications. ... MedlinePlus (medlineplus. ... eMedicine is an online clinical medical knowledge base that was founded in 1996. ... In genetics, the term recessive gene refers to an allele that causes a phenotype (visible or detectable characteristic) that is only seen in a homozygous genotype (an organism that has two copies of the same allele). ... A genetic disorder, or genetic disease is a disease caused, at least in part, by the genes of the person with the disease. ... For other uses, see Copper (disambiguation). ... Biological tissue is a collection of interconnected cells that perform a similar function within an organism. ... This article is about the branch of medicine. ... For the bird, see Liver bird. ... Heterozygote cells are diploid or polyploid and have different alleles at a locus (position) on homologous chromosomes. ... An asymptomatic carrier (or just carrier), is a person who is infected with an infectious disease or carries the abnormal gene of a recessive genetic disorder, but displays no symptoms. ... It has been suggested that mutant be merged into this article or section. ...

Contents

Signs and symptoms

Wilson disease is inherited in an autosomal recessive fashion.
Wilson disease is inherited in an autosomal recessive fashion.

Symptoms usually appear around the ages of 10 to 21 years, but sometimes not until the age of 30, and in rare instances at age 50 and even beyond. Presentation before 5 years of age is extremely rare, despite the biochemical defect being present at birth. Image File history File links No higher resolution available. ... Image File history File links No higher resolution available. ...


The age of presentation seems to correlate with the organ system involved. About half (40–50%) of patients first present with hepatic symptoms and half (40–50%) with neurologic symptoms. The average age for hepatic symptoms is 10–14 years, compared with 19–22 years for neurologic symptoms. Patients rarely present after age 40.


The main features are liver and neuropsychiatric problems. Chronic active hepatitis, culminating in cirrhosis is the most common hepatic presentation, but some patients present with fulminant liver failure (which is characterised by remarkably low alkaline phosphatase and often high bilirubin levels compared to similar disease states[1]) and a surprisingly rare incidence of hepatocellular carcinoma. Neuropsychiatric phenomena are early dementia, mood disorders or psychosis and signs of asterixis (a flapping tremor of the hands) and parkinsonism (including ataxia, dyskinesia, and rigidity). Hepatitis B is an inflammation of the liver and is caused by the Hepatitis B virus (HBV), a member of the Hepadnavirus family[1] and one of hundreds of unrelated viral species which cause viral hepatitis. ... Cirrhosis is a consequence of chronic liver disease characterized by replacement of liver tissue by fibrotic scar tissue as well as regenerative nodules, leading to progressive loss of liver function. ... Fulminant is any event or process which occurs suddenly, quickly and is intense and severe to the point of lethality, i. ... Liver failure is the final stage of liver disease. ... Ball and stick model of alkaline phosphatase Alkaline phosphatase (ALP) (EC 3. ... Bilirubin is a yellow breakdown product of normal heme catabolism. ... Hepatocellular carcinoma (HCC, also called hepatoma) is a primary malignancy (cancer) of the liver. ... For other uses, see Dementia (disambiguation). ... A mood disorder is a condition whereby the prevailing emotional mood is distorted or inappropriate to the circumstances. ... Psychosis is a generic psychiatric term for a mental state often described as involving a loss of contact with reality. Stedmans Medical Dictionary defines psychosis as a severe mental disorder, with or without organic damage, characterized by derangement of personality and loss of contact with reality and causing deterioration... Asterixis (Greek a, not + stērixis, fixed position) is a flapping tremor of the wrist upon extension (dorsiflexion), sometimes said to resemble a bird flapping its wings. Also called liver flap, it can be a sign of hepatic encephalopathy (damage to brain cells due to inability of the liver to... For the film see Tremors (film). ... Parkinsonism (also known as Parkinsons syndrome, atypical Parkinsons, or secondary Parkinsons) is a neurological syndrome characterized by tremor, hypokinesia, rigidity, and postural instability. ... For other uses, see Ataxia (disambiguation). ... Dyskinesia refers to an impairment of voluntary movement. ... In mathematics, suppose C is a collection of mathematical objects (for instance sets or functions). ...


Adjunctive features are renal (renal tubular acidosis, kidney stones), ophthalmic (Kayser-Fleischer rings, sunflower cataracts), cardiac (cardiomyopathy, cardiac arrhythmias) and dermal (hidradenitis suppurativa). Hemolysis (anemia due to destruction of red blood cells) is usually present only in severe cases. The kidneys are organs that filter wastes (such as urea) from the blood and excrete them, along with water, as urine. ... Renal tubular acidosis, or RTA, is a medical condition in which the kidneys fail to dispose of a normal amount of acid into the urine, which may lead to acidosis (where the blood becomes too acidic). ... Kidney stones are solid accretions (crystals) of dissolved minerals in urine found inside the kidneys or ureters. ... For other uses, see Eye (disambiguation). ... Kayser-Fleischer rings are pigmented rings in the peripheral cornea, resulting from copper deposition in Descemets membrane. ... Human eye cross-sectional view, showing position of human lens. ... The heart and lungs, from an older edition of Grays Anatomy. ... Cardiac arrhythmia is any of a group of conditions in which the electrical activity of the heart is irregular or is faster or slower than normal. ... Beyond overall skin structure, refer below to: See-also. ... Hidradenitis suppurativa or HS is a skin disease that affects areas bearing apocrine sweat glands and hair follicles; such as the underarms, groin and buttocks, and under the breasts in women. ... {{otheruses4|1=medical hemoglobin]] into the surrounding fluid (plasma, in vivo). ...


Diagnosis

A suppressed level of ceruloplasmin is present in over 80% of patients, and this is commonly performed as a screening test in patients with liver problems. A more accurate measurement is the direct testing for copper levels in a 24h specimen of urine, in the blood or in the sample obtained by liver biopsy. The average concentration of hepatic copper may reach 20 times normal levels, whilst plasma ceruloplasmin levels are typically less than 30% of normal. Ceruloplasmin Ceruloplasmin (or caeruloplasmin), officially known as ferroxidase or iron(II):oxygen oxidoreductase, is a copper transport protein found in the blood. ... Human blood smear: a - erythrocytes; b - neutrophil; c - eosinophil; d - lymphocyte. ... A biopsy (in Greek: bios = life and opsy = look/appearance) is a medical test involving the removal of cells or tissues for examination. ... Ceruloplasmin Ceruloplasmin (or caeruloplasmin), officially known as ferroxidase or iron(II):oxygen oxidoreductase, is a copper transport protein found in the blood. ...


An eye exam would detect the Kayser-Fleischer ring, although its absence does not rule out Wilson's and it may be missed on cursory examination. This sign is characterised by brown rings around the cornea in the eye that result from copper deposition in Descemet's membrane of the cornea. Wilson's disease is also associated with sunflower cataracts, brown or green pigmentation of the anterior and posterior lens capsule. Kayser-Fleischer rings are pigmented rings in the peripheral cornea, resulting from copper deposition in Descemets membrane. ... Descemets membrane is the basement membrane that lies between the corneal proper substance, also called stroma, and the endothelial layer of the cornea. ... The cornea is the transparent front part of the eye that covers the iris, pupil, and anterior chamber, providing most of an eyes optical power [1]. Together with the lens, the cornea refracts light and, as a result, helps the eye to focus. ...


Pathophysiology

The Wilson disease gene (ATP7B) has been mapped to chromosome 13 (13q14.3) and is expressed primarily in the liver, kidney, and placenta but has also been found in the heart, brain, and lung, albeit at much lower levels. The gene codes for a P-type ATPase that transports copper into bile and incorporates it into ceruloplasmin. Wilson disease protein is a ATPase which transports copper. ... Chromosome 13 is one of the 23 pairs of chromosomes in humans. ... The kidneys are organs that filter wastes (such as urea) from the blood and excrete them, along with water, as urine. ... The placenta is an ephemeral (temporary) organ present in female placental vertebrates, such as some mammals and sharks during gestation (pregnancy). ... The heart and lungs, from an older edition of Grays Anatomy. ... For other uses, see Brain (disambiguation). ... Human respiratory system The lungs flank the heart and great vessels in the chest cavity. ... ATPases are a class of enzymes that catalyze the decomposition of adenosine triphosphate (ATP) into adenosine diphosphate (ADP) and a free phosphate ion. ... Bile (or gall) is a bitter, yellow or green alkaline fluid secreted by hepatocytes from the liver of most vertebrates. ... Ceruloplasmin Ceruloplasmin (or caeruloplasmin), officially known as ferroxidase or iron(II):oxygen oxidoreductase, is a copper transport protein found in the blood. ...


The mutant form of ATP7B expressed in people with Wilson's disease inhibits the release of copper into bile. As the excretion of copper from the body is thus impaired, the copper builds up in the liver and injures liver tissue. Eventually, the damage causes the liver to release the copper directly into the bloodstream, which carries the copper throughout the body. The copper buildup leads to damage in the kidneys, brain, and eyes, presumably by generation of reactive oxygen species and binding to neuromelanin[1]. If not treated, Wilson's disease can cause severe brain damage, liver failure, and death. Reactive oxygen species (ROS) include oxygen ions, free radicals and peroxides both inorganic and organic. ... Broadly, melanin is any of the polyacetylene, polyaniline, and polypyrrole blacks and browns or their mixed copolymers. ... For other uses, see Death (disambiguation). ...


Copper deposits in the basal ganglia, particularly in the putamen and globus pallidus (together called the lenticular nucleus), result in cell death, producing symptoms akin to Parkinson's disease. The basal ganglia (or basal nuclei) are a group of nuclei in the brain interconnected with the cerebral cortex, thalamus and brainstem. ... The putamen is a structure in the middle of the brain, forming the striatum together with the caudate nucleus. ... The globus pallidus (Latin for pale body) is a sub-cortical structure in the brain. ... The lentiform nucleus or lenticular nucleus describes the putamen and the globus pallidus within the basal ganglia. ...


Treatment

The disease is treated with lifelong use of chelating agents such as D-penicillamine or trientine hydrochloride, drugs that help remove copper from tissue. Patients will also need to take vitamin B6 and follow a low-copper diet, which means avoiding mushrooms, nuts, chocolate, dried fruit, liver, and shellfish. Chelation (from Greek χηλή, chelè, meaning claw) is the process of reversible binding (complexation) of a ligand - the chelant, chelator, chelating agent, sequestering agent, or complexing agent - to a metal ion, forming a metal complex, the chelate. ... Penicillamine is a pharmaceutical of the chelator class. ... This article does not cite any references or sources. ... Biological tissue is a collection of interconnected cells that perform a similar function within an organism. ... Pyridoxine Pyridoxal phosphate Vitamin B6 is a water-soluble vitamin. ... For other uses, see Mushroom (disambiguation). ... For other uses, see Nut (disambiguation). ... For other uses, see Chocolate (disambiguation). ... For other uses, see Fruit (disambiguation). ... Cooked mussels Shellfish is a term used to describe shelled molluscs and crustaceans used as food. ...


Taking extra zinc may be helpful in blocking the intestines' absorption of copper. Zinc acetate is an agent utilized to inhibit copper absorption in patients with Wilson's disease. It blocks the intestinal absorption of the metal both from the diet and endogenous secretions. It also acts by producing metallothionein, a protein that binds with copper to prevent its release into the blood, and facilitates elimination via the stool. General Name, symbol, number zinc, Zn, 30 Chemical series transition metals Group, period, block 12, 4, d Appearance bluish pale gray Standard atomic weight 65. ... In anatomy, the intestine is the segment of the alimentary canal extending from the stomach to the anus and, in humans and other mammals, consists of two segments, the small intestine and the large intestine. ...


Liver transplantation is effective in patients with fulminant Wilson disease that does not respond to the usual treatment. Because the primary defect resides within the liver, transplantation is curative, but as it is only undertaken in severely ill patients the prognosis is still mediocre.


Epidemiology

In Western populations the incidence is around 1 per 30,000, with a carrier rate of 1 in 100. The gene frequency is much higher in Hispanics, especially in Central America, and in El Salvador, the incidence is 1 in 186. In Usulután Department, El Salvador it has been reported that 1 in 7 persons carry the disease.[citation needed] Usulután from the Lenca language Uxulvotan is a department of El Salvador in the southeast of the country ( Maya Lenca region). ...


History

The disease bears the name of the British physician Dr Samuel Alexander Kinnier Wilson (1878-1937), a neurologist[2] who described the condition in 1912.[3] Dr J.N. Cumings made the link with copper accumulation in 1948.[4] The first effective chelation agent, penicillamine, was discovered in 1956 by Dr John Walshe.[5] The genetic basis was elucidated in the 1980s and 1990s by several research groups.[6][7] This article is about the branch of medicine. ... 1912 (MCMXII) was a leap year starting on Monday in the Gregorian calendar (or a leap year starting on Tuesday in the 13-day-slower Julian calendar). ... Penicillamine is a pharmaceutical of the chelator class. ...


References

Original text is from a public domain source found at: http://www.niddk.nih.gov/health/digest/summary/wilson/wilson.htm The public domain comprises the body of all creative works and other knowledge—writing, artwork, music, science, inventions, and others—in which no person or organization has any proprietary interest. ...

  1. ^ Shaver WA, Bhatt H, Combes B. Low serum alkaline phosphatase activity in Wilson's disease. Hepatology 1986;6:859-63. PMID 3758940.
  2. ^ Dorland's Medical Dictionary
  3. ^ Wilson SAK. Progressive lenticular degeneration: a familial nervous disease associated with cirrhosis of the liver. Brain 1912;34:295-507.
  4. ^ Cumings JN. The copper and iron content of brain and liver in the normal and in hepato-lenticular degeneration. Brain 1948;71:410-5.
  5. ^ Walshe JM. Penicillamine, a new oral therapy for Wilson's disease. Am J Med 1956;21:487-95. PMID 13362281.
  6. ^ Tanzi RE, Petrukhin K, Chernov I, Pellequer JL, Wasco W et al, Ross B, Romano DM, Parano E, Pavone L, Brzustowicz LM, et al. The Wilson disease gene is a copper transporting ATPase with homology to the Menkes disease gene. Nat Genet 1993;5:344-50. PMID 8298641.
  7. ^ Bull PC, Thomas GR, Rommens JM, Forbes JR, Cox DW. The Wilson disease gene is a putative copper transporting P-type ATPase similar to the Menkes gene. Nat Genet 1993;5:327-37. PMID 8298639.

Dorlands Medical Dictionary was first published in 1890 as the American Illustrated Medical Dictionary including 770 pages. ...

External links


Who Named It is a Norwegian database of several thousand eponymous medical signs and the doctors associated with their identification. ... The U.S. National Library of Medicine (NLM), operated by the U.S. federal government, is the worlds largest medical research library. ... National Institutes of Health Building 50 at NIH Clinical Center - Building 10 The National Institutes of Health (NIH) is an agency of the United States Department of Health and Human Services and is the primary agency of the United States government responsible for biomedical research. ... The University of Washington, founded in 1861, is a public research university in Seattle, Washington. ...


  Results from FactBites:
 
WE MOVE Discussion Forum: Living with Wilson s Disease for 30 years (1877 words)
The symptoms of Wilson’s Disease are not limited only to such nerve abnormalities as tremor, overproduction of saliva, mental instability, etc., which are supposed to come from the damage to the brain because of the copper accumulation there.
Wilson’s Disease is said to be caused by the recessive genes to produce this particular physical constitution.
Wilson’s Disease is, as I mentioned above, the problems caused by the kind of physical constitution the patients were born with.
  More results at FactBites »


 

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