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Table 1 Current classification and treatment guidelines for PAH deficiency

From: Birth prevalence of phenylalanine hydroxylase deficiency: a systematic literature review and meta-analysis

Classification

Pretreatment blood phenylalanine concentration

Treatment recommended?

European guidelinesa

ACMGb

Classical PKU

 > 1200 µmol/L

(> 20 mg/dL)

Yes

Yes

Moderate PKU

900–1200 µmol/L

(15–20 mg/dL)

Yes

Yes

Mild PKU

600–900 µmol/L

(10–15 mg/dL)

Yes

Yes

Mild HPA-gray zone

360–600 µmol/L

(6–10 mg/dL)

Yes (only if < 12 years or in women before/during pregnancy)

Yesc

PAH deficiency not requiring treatment

120–360 µmol/L

(2–6 mg/dL)

No

No

  1. ACMG = American College of Medical Genetics and Genomics; HPA = hyperphenylalaninemia; PAH = phenylalanine hydroxylase; PKU = phenylketonuria
  2. avan Wegberg et al. [2]
  3. bVockley et al. [3]
  4. cAfter reviewing controversy regarding mixed treatment results with parents