Description

Congenital Insensitivity to Pain with Anhidrosis (CIPA) is a rare disorder that affects the afferent nervous system responsible for pain and temperature.


 

Chromosome location: 1q23.1

Gene affected: NTRK1 (receptor tyrosine kinase for nerve growth factor NGF)

 

Inheritance: autosomal recessive

 

Key clinical features:

(1) insensitivity to pain

(2) defective temperature sensation

(3) anhidrosis with fever and heat intolerance

 

Variable findings:

(1) self-mutilating behavior

(2) immunodeficiency with reduced immunoglobulins and recurrent infections

(3) mental retardation

 

Affected patients fail a number of pharmacologic stimulation tests:

(1) lacrimation following subcutaneous injection of neostigmine

(2) unresponsiveness to mehacholine

(3) absence of a flare response to histamine

(4) absence of sweating following any normal stimulus

 

A skin biopsy shows histologically normal sweat glands.

 

Naloxone therapy can be effective in these patients (Yanagida, 1978)

 


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