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Living with Hyperornithinemia-hyperammonemia-homocitrullinuria syndrome

A rare genetic condition of the urea cycle, which clears ammonia, causing brain, liver, and feeding problems.

Understanding Hyperornithinemia-hyperammonemia-homocitrullinuria syndrome

Hyperornithinemia-hyperammonemia-homocitrullinuria (HHH) syndrome is a rare genetic disorder of urea cycle metabolism.

It can start in newborns with low energy, poor feeding, vomiting, and fast breathing. More often it appears in infancy, childhood, or adulthood with long-term thinking and learning problems, sudden brain illness (acute encephalopathy), blood clotting problems, or other chronic liver problems.

Signs & symptoms

Symptoms vary from person to person. GARD lists these among the most common:

  • Low energy (lethargy)
  • Poor feeding and vomiting
  • Sudden brain illness (acute encephalopathy)
  • Cognitive impairment
  • Enlarged liver and reduced liver function
  • Increased reflexes and poor coordination

Not everyone has every symptom. GARD's list comes from the Human Phenotype Ontology.

Diagnosis

  1. Talk with your doctor

    Share the symptoms you've noticed, when they started and your family health history. Notes and photos can help.

  2. See a specialist

    Specialists who may be involved include brain and nervous system specialists and genetic specialists.

  3. Consider genetic testing

    Changes in SLC25A15 are linked to this condition. Genetic testing and counseling can help confirm a diagnosis and explain what it means for your family.

Care & treatment

Care team
Brain and nervous system specialists (neurologists); Genetic specialists (geneticists)
Expert care
Ask about multidisciplinary care centers for rare conditions
Treatment
GARD doesn't list specific treatments for this condition. Your care team will tailor care to your symptoms.
Research
Clinical trials and observational studies may be options. See the research section below.

General information, not medical advice. Your care team makes the decisions.

Everyday life

Living with a rare condition is easier with support.

  • Connect with National Urea Cycle Disorders Foundation
  • Keep notes on symptoms, changes and questions for appointments
  • Ask about patient registries that help research
  • Look into financial aid and travel resources for care visits
Bring these questions to your next doctor visit
Which diet or medicines help keep ammonia low?
Which signs mean we should seek care right away?
Would genetic testing for SLC25A15 help our family?

Quick facts

Symptoms usually starta variety of ages
InheritanceAutosomal Recessive
GenesSLC25A15

Changes in the SLC25A15 gene cause this condition. It is autosomal recessive, so a child inherits a changed copy of the gene from each parent.

GeneticNeurologicalInherited Metabolic

Also known as: hhh - hyperornithinemia-hyperammonemia-homocitrullinuria syndrome; hhh syndrome; hhhs; hyperornithinemia-hyperammonemia-homocitrullinemia syndrome; hyperornithinemia-hyperammonemia-homocitrullinuria (hhh) syndrome; ornithine carrier deficiency

Patient organizations

Source: NIH GARD · Hyperornithinemia-hyperammonemia-homocitrullinuria syndromeGARD ID 2830 · GARD page updated September 2026 · Plain-language summary by Know Rare; editorial review pending. General information, not medical advice.

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