Test Catalog

Test Id : PKU

Phenylalanine and Tyrosine, Plasma

Useful For
Suggests clinical disorders or settings where the test may be helpful

Monitoring effectiveness of dietary therapy in patients with hyperphenylalaninemia

Genetics Test Information
Provides information that may help with selection of the correct genetic test or proper submission of the test request

Defects in phenylalanine hydroxylase (PAH) cause the majority of cases of hyperphenylalaninemia (HPA); however, approximately 2% of infants with HPA have impaired synthesis or recycling of tetrahydrobiopterin (BH4).

 

Phenylketonuria: Evaluation of patients with hyperphenylalaninemia or monitoring effectiveness of dietary therapy. This test is not sufficient follow-up for abnormal newborn screening results, because other causes of hyperphenylalaninemia (eg, BH4 deficiency) cannot be excluded by this test alone.

 

Tyrosinemia, type I: For medical management.

Method Name
A short description of the method used to perform the test

Liquid Chromatography-Tandem Mass Spectrometry (LC-MS/MS)

NY State Available
Indicates the status of NY State approval and if the test is orderable for NY State clients.

Yes

Reporting Name
Lists a shorter or abbreviated version of the Published Name for a test

Phenylalanine and Tyrosine, P

Aliases
Lists additional common names for a test, as an aid in searching

Phenylalanine Includes Tyrosine

PKU (Phenylketonuria)

Tyrosine

Tyrosinemia

Hyperphenylalaninemia

Specimen Type
Describes the specimen type validated for testing

Plasma

Necessary Information

1. Patient's age is required.

2. Include family history, clinical condition (asymptomatic or acute episode), diet, and drug therapy information.

Specimen Required
Defines the optimal specimen required to perform the test and the preferred volume to complete testing

Patient Preparation: Fasting (4 hours or more for infants)

Collection Container/Tube:

Preferred: Green top (sodium heparin)

Acceptable: Lavender top (EDTA)

Submission Container/Tube: Plastic vial

Specimen Volume: 0.5 mL

Forms

Specimen Minimum Volume
Defines the amount of sample necessary to provide a clinically relevant result as determined by the Testing Laboratory

0.1 mL

Reject Due To
Identifies specimen types and conditions that may cause the specimen to be rejected

Gross hemolysis OK
Gross lipemia OK
Gross icterus OK

Specimen Stability Information
Provides a description of the temperatures required to transport a specimen to the performing laboratory, alternate acceptable temperatures are also included

Specimen Type Temperature Time Special Container
Plasma Frozen (preferred) 14 days
Refrigerated 14 days

Useful For
Suggests clinical disorders or settings where the test may be helpful

Monitoring effectiveness of dietary therapy in patients with hyperphenylalaninemia

Genetics Test Information
Provides information that may help with selection of the correct genetic test or proper submission of the test request

Defects in phenylalanine hydroxylase (PAH) cause the majority of cases of hyperphenylalaninemia (HPA); however, approximately 2% of infants with HPA have impaired synthesis or recycling of tetrahydrobiopterin (BH4).

 

Phenylketonuria: Evaluation of patients with hyperphenylalaninemia or monitoring effectiveness of dietary therapy. This test is not sufficient follow-up for abnormal newborn screening results, because other causes of hyperphenylalaninemia (eg, BH4 deficiency) cannot be excluded by this test alone.

 

Tyrosinemia, type I: For medical management.

Clinical Information
Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test

Phenylketonuria (PKU) is the most frequent inherited disorder of amino acid metabolism (about 1:10,000-1:15,000) and was the first successfully treated inborn error of metabolism. It is inherited in an autosomal recessive manner and is caused by a defect in the enzyme phenylalanine hydroxylase (PAH), which converts the essential amino acid phenylalanine to tyrosine. Deficiency of PAH results in decreased levels of tyrosine and an accumulation of phenylalanine in blood and tissues. Untreated, PKU leads to severe brain damage with intellectual impairment, behavior abnormalities, seizures, and spasticity. The level of enzyme activity differentiates classic PKU (PAH activity <1%) from other milder forms; however, all are characterized by increased levels of phenylalanine (hyperphenylalaninemia). Treatment includes the early introduction of a diet low in phenylalanine.

 

Tetrahydrobiopterin (BH4) is a cofactor of not only PAH, but also of the tyrosine and tryptophan hydroxylases. Approximately 2% of patients with hyperphenylalaninemia have a deficiency of BH4, which causes a secondary deficit of the neurotransmitters dopamine and serotonin. There are 4 autosomal-recessive disorders associated with BH4 deficiency plus hyperphenylalaninemia; guanosine triphosphate cyclohydrolase deficiency, 6-pyruvoyl tetrahydropterine synthase deficiency, dihydropteridine reductase deficiency, and pterin-4 alpha carbinolamine dehydratase (PCD) deficiency. This group of disorders, with the exception of PCD, is characterized by progressive dystonia, truncal hypotonia, extremity hypertonia, seizures, and intellectual disability though milder presentations exist. PCD has no symptoms other than transient alterations in tone. Treatment may include administration of BH4, L-dopa (and carbidopa) 5-hydroxytryptophan supplements, and a low phenylalanine diet.

 

Tyrosine is a nonessential amino acid that derives from dietary sources, the hydroxylation of phenylalanine, or protein breakdown. Primary (PKU) and secondary (defects of BH4 metabolism) hyperphenylalaninemia can cause abnormally low levels of tyrosine. Measurement of the phenylalanine:tyrosine ratio is helpful in monitoring appropriate dietary intake.

Reference Values
Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.

PHENYLALANINE

Premature: 98-213 nmol/mL

0-31 days: 38-137 nmol/mL

1-24 months: 31-75 nmol/mL

2-18 years: 26-91 nmol/mL

> or =19 years: 35-85 nmol/mL

 

Conversion Formulas:

Result in mg/dL x 60.5=result in nmol/mL

Result in nmol/mL x 0.0165=result in mg/dL

 

TYROSINE

Premature: 147-420 nmol/mL

0-31 days: 55-147 nmol/mL

1-24 months: 22-108 nmol/mL

2-18 years: 24-115 nmol/mL

> or =19 years: 34-112 nmol/mL

 

Conversion Formulas:

Result in mg/dL x 55.2=result in nmol/mL

Result in nmol/mL x 0.0181=result in mg/dL

Interpretation
Provides information to assist in interpretation of the test results

The quantitative results of phenylalanine and tyrosine with age-dependent reference values are reported without added interpretation. When applicable, reports of abnormal results may contain an interpretation based on available clinical interpretation.

 

A phenylalanine:tyrosine ratio higher than 3 is considered abnormal.

Cautions
Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances

This test is not sufficient to establish a diagnosis of hyperphenylalaninemia.

Clinical Reference
Recommendations for in-depth reading of a clinical nature

1. Mitchell GA, Grompe M, Lambert M, Tanguay RM: Hypertyrosinemia. In: Valle DL, Antonarakis S, Ballabio A, Beaudet AL, Mitchell GA, eds. The Online Metabolic and Molecular Bases of Inherited Disease. McGraw-Hill; 2019. Accessed November 05, 2020. Available at https://ommbid.mhmedical.com/content.aspx?bookid=2709&sectionid=2250828252

2. Donlon J, Sarkissian C, Levy H, Scriver CR: Hyperphenylalaninemia: Phenylalanine hydroxylase deficiency. In: Valle DL, Antonarakis S, Ballabio A, Beaudet AL, Mitchell GA, eds. The Online Metabolic and Molecular Bases of Inherited Disease. McGraw-Hill; 2019. Accessed November 05, 2020. Available at https://ommbid.mhmedical.com/content.aspx?bookid=2709&sectionid=225081923

3. Burgard P, Luo X, Hoffmann GF: Phenylketonuria. In: Sarafoglou K, Hoffman GF, Roth KS, eds. Pediatric Endocrinology and Inborn Errors of Metabolism. McGraw-Hill Medical Division; 2009:163-168

4. Blau N, Thony B: Hyperphenylalanemias: Disorders of tetrahydrobiopterin metabolism. In: Sarafoglou K, Hoffmann GF, Roth KS, eds. Pediatric Endocrinology and Inborn Errors of Metabolism. McGraw-Hill Medical Division; 2009:169-175

Method Description
Describes how the test is performed and provides a method-specific reference

This method quantifies phenylalanine (Phe) and tyrosine (Tyr) using stable isotope-labeled internal standards (IS): d5-Phe and d4-Tyr. Phe and Tyr are extracted from plasma using methanol:water (50:50) solution containing the IS. The mixture is vortexed and centrifuged to precipitate protein. The supernatant is diluted and then introduced into the tandem mass spectrometer (MS/MS). The concentration of Phe and Tyr are established by comparison of the ion intensity with that of the IS (d5-Phe and d4-Tyr, respectively).(Unpublished Mayo method)

PDF Report
Indicates whether the report includes an additional document with charts, images or other enriched information

No

Day(s) Performed
Outlines the days the test is performed. This field reflects the day that the sample must be in the testing laboratory to begin the testing process and includes any specimen preparation and processing time before the test is performed. Some tests are listed as continuously performed, which means that assays are performed multiple times during the day.

Monday through Friday

Report Available
The interval of time (receipt of sample at Mayo Clinic Laboratories to results available) taking into account standard setup days and weekends. The first day is the time that it typically takes for a result to be available. The last day is the time it might take, accounting for any necessary repeated testing.

2 to 4 days

Specimen Retention Time
Outlines the length of time after testing that a specimen is kept in the laboratory before it is discarded

2 weeks

Performing Laboratory Location
Indicates the location of the laboratory that performs the test

Rochester

Fees
Several factors determine the fee charged to perform a test. Contact your U.S. or International Regional Manager for information about establishing a fee schedule or to learn more about resources to optimize test selection.

  • Authorized users can sign in to Test Prices for detailed fee information.
  • Clients without access to Test Prices can contact Customer Service 24 hours a day, seven days a week.
  • Prospective clients should contact their Regional Manager. For assistance, contact Customer Service.

Test Classification
Provides information regarding the medical device classification for laboratory test kits and reagents. Tests may be classified as cleared or approved by the US Food and Drug Administration (FDA) and used per manufacturer instructions, or as products that do not undergo full FDA review and approval, and are then labeled as an Analyte Specific Reagent (ASR) product.

This test was developed, and its performance characteristics determined by Mayo Clinic in a manner consistent with CLIA requirements. This test has not been cleared or approved by the US Food and Drug Administration.

CPT Code Information
Provides guidance in determining the appropriate Current Procedural Terminology (CPT) code(s) information for each test or profile. The listed CPT codes reflect Mayo Clinic Laboratories interpretation of CPT coding requirements. It is the responsibility of each laboratory to determine correct CPT codes to use for billing.

CPT codes are provided by the performing laboratory.

84030-Phenylalanine

84510-Tyrosine

LOINC® Information
Provides guidance in determining the Logical Observation Identifiers Names and Codes (LOINC) values for the order and results codes of this test. LOINC values are provided by the performing laboratory.

Test Id Test Order Name Order LOINC Value
PKU Phenylalanine and Tyrosine, P In Process
Result Id Test Result Name Result LOINC Value
Applies only to results expressed in units of measure originally reported by the performing laboratory. These values do not apply to results that are converted to other units of measure.
8380 Phenylalanine, P 14875-9
8627 Tyrosine, P 20660-7

Test Setup Resources

Setup Files
Test setup information contains test file definition details to support order and result interfacing between Mayo Clinic Laboratories and your Laboratory Information System.

Excel | Pdf

Sample Reports
Normal and Abnormal sample reports are provided as references for report appearance.

Normal Reports | Abnormal Reports

SI Sample Reports
International System (SI) of Unit reports are provided for a limited number of tests. These reports are intended for international account use and are only available through MayoLINK accounts that have been defined to receive them.

SI Normal Reports | SI Abnormal Reports