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Menkes disease

Steely hair disease; Menkes kinky hair syndrome; Kinky hair disease; Copper transport disease; Trichopoliodystrophy; X-linked copper deficiency

Menkes disease is a genetic disorder in which the body has a problem absorbing and distributing copper to bodily organs. The disease affects development, both mental and physical.

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Causes

Menkes disease is caused by a defect in the ATP7A gene. The defect makes it hard for the body to properly distribute (transport) copper throughout the body. As a result, the brain and other parts of the body do not get enough copper, while it builds up in the small intestine and kidneys. A low copper level can affect the structure of bone, skin, hair, and blood vessels, and interfere with nerve function.

Menkes syndrome is usually inherited, which means it runs in families. The gene is on the X-chromosome, so if a mother carries the defective gene, each of her sons has a 50% (1 in 2) chance of developing the disease, and 50% of her daughters will be a carrier of the disease. This kind of gene inheritance is called X-linked recessive.

In some people, the disease is not inherited from their parents. Instead, the gene defect occurs at the time the baby is conceived.

Symptoms

Common symptoms of Menkes disease in infants are:

• Brittle, kinky, steely, sparse, or tangled hair
• Pudgy, rosy cheeks, sagging facial skin
• Feeding difficulties
• Irritability
• Decreased muscle tone (hypotonia), floppiness
• Low body temperature
• Intellectual disability and developmental delay
• Seizures
• Skeletal changes

Exams and Tests

Once Menkes disease is suspected, tests that may be done include:

• Ceruloplasmin blood test (substance that transports copper in the blood)
• Copper blood test
• Skin cell culture
• X-ray of the skeleton or x-ray of the skull
• Gene testing to check for defect of the ATP7A gene

Treatment

Treatment usually only helps when started very early in the course of the disease. Injections of copper into a vein or under the skin have been used with mixed results and depend on whether the ATP7A gene still has some activity.

Support Groups

More information and support for people with Menkes syndrome and their families can be found at:

• National Organization for Rare Disorders -- rarediseases.org/rare-diseases/menkes-disease/
• NIH Genetic and Rare Diseases Information Center -- rarediseases.info.nih.gov/diseases/1521/menkes-disease

Outlook (Prognosis)

Most children with this disease die within the first few years of life.

When to Contact a Medical Professional

Talk to your provider if you have a family history of Menkes syndrome and you plan to have children. A baby with this condition will often show symptoms early in infancy.

Prevention

See a genetic counselor if you want to have children and you have a family history of Menkes syndrome. Maternal relatives (relatives on the mother's side of the family) of a boy with this syndrome could be seen by a geneticist to find out if they are carriers.

References

Kwon JM. Neurodegenerative disorders of childhood. In: Kliegman RM, St. Geme JW, Blum NJ, Shah, SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 617.

Turnpenny PD, Ellard S, Cleaver R. Inborn errors of metabolism. In: Turnpenny PD, Ellard S, Cleaver R, eds. Emery's Elements of Medical Genetics and Genomics. 16th ed. Philadelphia, PA: Elsevier; 2022:chap 18.

Review Date: 4/24/2023  

Reviewed By: Anna C. Edens Hurst, MD, MS, Associate Professor in Medical Genetics, The University of Alabama at Birmingham, Birmingham, AL. Review provided by VeriMed Healthcare Network. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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