Medium Chain Acyl-CoA Dehydrogenase Deficiency (MCAD)

Medium Chain Acyl-CoA Dehydrogenase Deficiency (MCAD) is a rare genetic disorder that affects the body's ability to convert certain fats to energy.

Causes and Inheritance

MCAD is caused by a deficiency of the medium-chain acyl-CoA dehydrogenase enzyme, which is necessary for the breakdown of medium-chain fatty acids. This enzyme is involved in the process of beta-oxidation, where fatty acids are converted into energy. The deficiency is usually inherited in an autosomal recessive pattern, meaning that a person must inherit two copies of the mutated gene (one from each parent) to develop the condition.

Symptoms

The symptoms of MCAD can vary in severity and may include:

• Fatigue or weakness
• Loss of appetite
• Vomiting
• Diarrhea
• Abdominal pain
• Hypoglycemia (low blood sugar)
• Seizures
• Coma

Diagnosis

MCAD can be diagnosed through a combination of the following tests:

• Newborn screening: Many states include MCAD in their newborn screening programs, which involve testing a blood sample from the heel of a newborn baby.
• Acylcarnitine profile: This test measures the levels of different acylcarnitines in the blood, which can be abnormal in people with MCAD.
• Genetic testing: This test can identify the mutated gene that causes MCAD.
• Enzyme assay: This test measures the activity of the medium-chain acyl-CoA dehydrogenase enzyme in a blood sample or tissue biopsy.

Treatment and Management

The treatment for MCAD typically involves:

• Dietary restrictions: Avoiding fasting and following a low-fat diet can help manage the condition.
• Supplementation: Taking L-carnitine and medium-chain triglyceride (MCT) oil supplements can help support energy production.
• Monitoring: Regular monitoring of blood sugar levels, liver function, and other health parameters is important to prevent complications.

Complications

If left untreated or poorly managed, MCAD can lead to serious complications, including:

• Hypoglycemic coma
• Seizures
• Cardiac problems
• Liver disease
• Sudden death

Prognosis

With proper treatment and management, people with MCAD can lead normal lives. However, the condition requires lifelong monitoring and adherence to dietary restrictions to prevent complications.