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Pyroluria


more straightforward than methylation piece in psych workup/dx
genetic disorder, runs in families
implicated in depression, anx, bipolar, schizo, autism, OCD, others

defect in heme catabolism
byproducts cleave to zinc and B6 which are then disproportionately excreted in urine

DX
start with zinc tally test
serum zinc/copper, cu/zn will be incr in endocine disorders

LABS
urine test for excess B6 excretion:
urine kryptopyrrole, Lab Corps does it
https://www.labcorp.com/wps/portal/
(today 3/18/11 contacted labcorp re setting up new account)

SX
zinc and B6 def sx
migraine
chronic fatigue
chronic pain
psych conditions

TX
supp B6 and zinc
B6 start with P5P at 100mg/day
zinc start with 50mg/day, most pts stay there, some need more
supplementation needed lifelong or during periods of stress
avoid copper sources: copper IUD may exacerbate condition
shellfish, liver are main foods to avoid

SOURCES
Elissa Mendenhall grand rounds Feb 2011

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