Sections View Full Chapter Figures Tables Videos Annotate Full Chapter Figures Tables Videos Supplementary Content + Download Section PDF Listen ++ For further information, see CMDT Part 40-20: Disorders of Homocysteine Metabolism + Key Features Download Section PDF Listen +++ ++ Caused by cystathionine beta-synthase deficiency, which results in extreme elevations of plasma and urinary homocysteine levels Autosomal recessive inheritance + Clinical Findings Download Section PDF Listen +++ ++ Similar to Marfan syndrome in body habitus Ectopia lentis almost always present Mental impairment often present Cardiovascular events caused by repeated arterial or venous thromboses Bone mineral density is reduced in untreated patients Life expectancy is reduced, especially in untreated and pyridoxine-unresponsive patients Myocardial infarction, stroke, and pulmonary embolism are most common causes of death + Diagnosis Download Section PDF Listen +++ ++ Diagnosis suspected in patients in the second and third decades of life who have repeated arterial or venous thromboses and no other risk factors DNA analysis can detect mutations in the cystathionine beta-synthase gene Amino acid analysis of plasma is helpful diagnostic test: elevated plasma methionine and homocysteine levels + Treatment Download Section PDF Listen +++ ++ About 50% patients have a form of cystathionine beta-synthase deficiency that improves biochemically and clinically with pharmacologic doses of pyridoxine (50–500 mg/day) and folate (5–10 mg/day) Treatment from infancy can prevent mental impairment and the other clinical problems Patients who do not respond to pyridoxine must be treated with dietary reduction in methionine and supplementation of cysteine beginning in infancy Vitamin betaine useful in reducing plasma methionine levels Anticoagulation for documented venous thrombosis Prophylactic use of warfarin or antiplatelet agents not recommended