adrenoleukodystrophy (ALD) is a rare inherited genetic disorder. There are 40 subtypes of leukodystrophy. X-linked ALD is the most common category. ALD results in degeneration of the: Myelin sheath—the fatty insulation covering on nerve fibers in the brainAdrenal gland and surrounding adrenal cortex—they produce vital hormones
Myelin Sheath Around Nerve Fiber
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There are 6 subtypes of X-linked ALD: Childhood cerebral ALDAdolescent ALDAdrenomyeloneuropathyAdult cerebral ALDAdrenal insufficiency-onlySymptomatic heterozygotes
Adrenoleukodystrophy (ALD) is caused by an inherited defective gene.
In people with ALD, the body cannot properly break down fatty acids. This results in a build up of saturated fatty acids in the brain and the adrenal cortex. This causes damage to the myelin sheath in the brain and adrenal gland.
This condition is most common in males, although females may also be affected. It is also more common in children and young adults. Having a mother who carries the defective X-linked adrenoleukodystrophy (ALD) gene may increase your risk.
Symptoms can vary within the types of ALD.
This form is the most severe. It only affects boys. Symptoms usually begin between 2–10 years of age. About 35% of boys can have severe symptoms during the early phase. On average, death results in 2 years, though some may live a couple of decades.
Initial symptoms include: Behavioral changesPoor memoryA slowing down of thought processes and physical activityDevelopmental regression
As the disease progresses, more serious symptoms develop. These include: Vision lossSeizuresHearing lossDifficulty swallowing and speakingDifficulty with walking and coordinationVomitingFatigue
Increased pigmentation of the skin, due to adrenal hormone deficiency—Addison diseaseProgressive dementiaVegetative state or death
This type is similar to the childhood type. It begins around 11-21 years of age. The progression is usually slower.
This is the most common form. Symptoms of AMN can present in the 20's. It progresses slowly. Symptoms can include: Weakness, clumsiness, weight loss, and nausea
Emotional disturbances or
depressionMotor/movement problems, such as walking problems
Urinary problems or
With this type, symptoms usually do not appear until young adulthood (20's) or middle age (50's). It causes symptoms similar to
dementia. It usually progresses quickly. Death or a vegetative state can occur in 3-4 years.
This form is only seen in women. Symptoms may be mild or severe. It usually does not affect the adrenal gland function.
You will be asked about your symptoms and medical history. A physical exam will be done.
Your bodily fluids may be tested. This can be done with: Blood testsGenetic testing
Images may be taken of your brain. This can be done with an
There is no known cure for the brain damage of adrenoleukodystrophy (ALD). However, the adrenal deficiency can be treated with cortisone replacement. ALD often causes death within 10 years of the onset of symptoms.
Some therapies can help manage the symptoms of ALD.
These include: Physical therapyPsychological therapySpecial education for children
There are also some experimental treatments.
Some treatments that are still being investigated that you may want to talk to your doctor about include: Bone marrow transplantation—this procedure may be most helpful when given early to boys with X-linked child-onset ALD
Dietary therapy, which includes consumption of:
A low-fat dietLorenzo’s oil—a dietary supplements of glycerol trioleate and glycerol trierucate Lovastatin—an anticholesterol medicationMedications that affect interactions between DNA and other proteins
There is no known way to prevent ALD. If you have ALD or have a family history of the disorder, you can talk to a genetic counselor when deciding to have children.
Early recognition and treatment may prevent symptoms from developing. New technologies may soon allow early identification through newborn screening.
Berger J, Pujol A, et al. Current and future pharmacologic treatment strategies in X-linked adrenoleukodystrophy.
Brain Pathol. 2010;20(4):845-856.
Moser HW. Therapy of X-linked adrenoleukodystrophy.
Moser HW, Raymond GV, et al. Adrenoleukodystrophy: new approaches to a neurodegenerative disease.
Moser HW, Raymond GV, et al. Follow-up of 89 asymptomatic patients with adrenoleukodystrophy treated with
Arch Neurol. 2005;62(7):1073-1080.
NINDS adrenoleukodystrophy information page.
National Institute of Neurological Disorders and Stroke website. Available at:
http://www.ninds.nih.gov/disorders/adrenoleukodystrophy/adrenoleukodystrophy.htm. Updated March 31, 2016. Accessed June 6, 2016.
Last reviewed June 2016 by Kari Kassir, MD
Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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