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Purpose: X-linked adrenoleukodystrophy(ALD) is a rare disorder that shows a great deal of phenotypic variability. We subdivided chidhood X- linked ALD patients into several phenotypes by the age at onset, the sites of most severe clinical involvement and the rate of progression of neurologic symptoms.Methods: Fourteen patients who had been diagnosed as X- linked ALD and followed up for at least one year were enrolled from 1996 to 2010.Results: 1. Eleven had childhood cerebral ALD, who showed first neurologic symptoms at 7.29 years and progressed rapidly: interval between first symptoms and vegetative state was 1.48 years, and interval from initial symptoms to death was 3.44 years. Treatment with Lorenzo's oil did not prevent neurologic progression. Two patients who underwent umbilical cord blood transplantation died. 2. Two had adolescent cerebral ALD. They had first symptoms at 11.5 years, and showed tendency to progress less rapidly than childhood cerebral form patients. 3. One "Addison only" patient who had adrenal insufficiency without nervous system involvement remained asymptomatic during Lorenzo's oil treatment. 4. Most cerebral form patients except two showed the lesions in both parieto-ocipital white matter in brain magnetic resonance imaging. Conclusion: The cerebral ALD was the most common form in childhood and was asoociated with a grave prognosis.

X-linked adrenoleukodystrophy, Childhood, Phenotype