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THE PORPHYRIAS: INTRODUCTION
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The porphyrias are metabolic disorders, each resulting from the deficiency or increased activity of a specific enzyme in the heme biosynthetic pathway (Fig. 409-1 and Table 409-1). These enzyme disorders are inherited as autosomal dominant, autosomal recessive, or X-linked traits, with the exception of porphyria cutanea tarda (PCT), which is usually sporadic (Table 409-1). The porphyrias are classified as either hepatic or erythropoietic, depending on the primary site of overproduction and accumulation of their respective porphyrin precursors or porphyrins (Tables 409-1 and 409-2), although some have overlapping features. For example, PCT, the most common porphyria, is hepatic and presents with blistering cutaneous photosensitivity, which is typically characteristic of the erythropoietic porphyrias (EPPs).
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