1
|
Niculae AȘ, Bolba C, Grama A, Mariş A, Bodea L, Căinap S, Mititelu A, Fufezan O, Pop TL. Wolcott-Rallison Syndrome, a Rare Cause of Permanent Diabetes Mellitus in Infants-Case Report. Pediatr Rep 2023; 15:608-616. [PMID: 37873802 PMCID: PMC10594453 DOI: 10.3390/pediatric15040056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/02/2023] [Accepted: 10/04/2023] [Indexed: 10/25/2023] Open
Abstract
Wolcott-Rallison syndrome is a rare cause of permanent neonatal diabetes mellitus caused by mutations in the eukaryotic translation initiation factor 2 alpha kinase 3 gene (EIF2AK3). Individuals affected by this disorder have severe hyperglycemia, pancreatic failure, and bone abnormalities and are prone to severe and life-threatening episodes of liver failure. This report illustrates the case of a 2-month-old infant with extreme hyperglycemia and severe diabetic ketoacidosis. Acute management was focused on correcting severe acidosis. Further management aimed to obtain stable blood glucose levels, balancing the patient's need for comfort and lack of distress with the clinicians' need for adequate information regarding the patient's glycemic control. Genetic testing of the patient and his parents confirmed the diagnosis. The follow-up for 18 months after diagnosis is detailed, illustrating both the therapeutic success of subcutaneous insulin therapy and the ongoing complications that patients with Wolcott-Rallison syndrome are subject to.
Collapse
Affiliation(s)
- Alexandru-Ștefan Niculae
- 2nd Pediatric Discipline, Department of Mother and Child, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, 400177 Cluj-Napoca, Romania; (A.-Ș.N.); (S.C.); (A.M.); (T.L.P.)
| | - Claudia Bolba
- 2nd Pediatric Clinic, Emergency Clinical Hospital for Children Cluj-Napoca, 400177 Cluj-Napoca, Romania;
| | - Alina Grama
- 2nd Pediatric Discipline, Department of Mother and Child, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, 400177 Cluj-Napoca, Romania; (A.-Ș.N.); (S.C.); (A.M.); (T.L.P.)
- 2nd Pediatric Clinic, Emergency Clinical Hospital for Children Cluj-Napoca, 400177 Cluj-Napoca, Romania;
| | - Alexandra Mariş
- Intesive Care Unit, Emergency Clinical Hospital for Children Cluj-Napoca, 400370 Cluj-Napoca, Romania; (A.M.); (L.B.)
| | - Laura Bodea
- Intesive Care Unit, Emergency Clinical Hospital for Children Cluj-Napoca, 400370 Cluj-Napoca, Romania; (A.M.); (L.B.)
| | - Simona Căinap
- 2nd Pediatric Discipline, Department of Mother and Child, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, 400177 Cluj-Napoca, Romania; (A.-Ș.N.); (S.C.); (A.M.); (T.L.P.)
- 2nd Pediatric Clinic, Emergency Clinical Hospital for Children Cluj-Napoca, 400177 Cluj-Napoca, Romania;
| | - Alexandra Mititelu
- 2nd Pediatric Discipline, Department of Mother and Child, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, 400177 Cluj-Napoca, Romania; (A.-Ș.N.); (S.C.); (A.M.); (T.L.P.)
| | - Otilia Fufezan
- Department of Imaging, Emergency Clinical Hospital for Children Cluj-Napoca, 400370 Cluj-Napoca, Romania;
| | - Tudor Lucian Pop
- 2nd Pediatric Discipline, Department of Mother and Child, Iuliu Hatieganu University of Medicine and Pharmacy Cluj-Napoca, 400177 Cluj-Napoca, Romania; (A.-Ș.N.); (S.C.); (A.M.); (T.L.P.)
- 2nd Pediatric Clinic, Emergency Clinical Hospital for Children Cluj-Napoca, 400177 Cluj-Napoca, Romania;
| |
Collapse
|
2
|
de Gouveia Buff Passone C, Giani E, Vaivre-Douret L, Kariyawasam D, Berdugo M, Garcin L, Beltrand J, Bernardo WM, Polak M. Sulfonylurea for improving neurological features in neonatal diabetes: A systematic review and meta-analyses. Pediatr Diabetes 2022; 23:675-692. [PMID: 35657808 DOI: 10.1111/pedi.13376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 05/19/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE In monogenic diabetes due to KCNJ11 and ABCC8 mutations that impair KATP- channel function, sulfonylureas improve long-term glycemic control. Although KATP channels are extensively expressed in the brain, the effect of sulfonylureas on neurological function has varied widely. We evaluated published evidence about potential effects of sulfonylureas on neurological features, especially epilepsy, cognition, motor function and muscular tone, visuo-motor integration, and attention deficits in children and adults with KCNJ11 and ABCC8-related neonatal-onset diabetes mellitus. RESEARCH DESIGN AND METHODS We conducted a systematic review and meta-analyses of the literature (PROSPERO, CRD42021254782), including individual-patient data, according to PRISMA, using RevMan software. We also graded the level of evidence. RESULTS We selected 34 of 776 publications. The evaluation of global neurological function before and after sulfonylurea (glibenclamide) treatment in 114 patients yielded a risk difference (RD) of 58% (95%CI, 43%-74%; I2 = 54%) overall and 73% (95%CI, 32%-113%; I2 = 0%) in the subgroup younger than 4 years; the level of evidence was moderate and high, respectively. EEG studies of epilepsy showed a RD of 56% (95%CI, 23%-89%; I2 = 34%) in patients with KCNJ11 mutations, with a high quality of evidence. For hypotonia and motor function, the RDs were 90% (95%CI, 69%-111%; I2 = 0%) and 73% (95%CI, 35%-111%; I2 = 0%), respectively, with a high level of evidence. CONCLUSIONS Glibenclamide significantly improved neurological abnormalities in patients with neonatal-onset diabetes due to KCNJ11 or ABCC8 mutations. Hypotonia was the symptom that responded best. Earlier treatment initiation was associated with greater benefits.
Collapse
Affiliation(s)
- Caroline de Gouveia Buff Passone
- Pediatric Endocrinology, Gynaecology and Diabetology, Centre de Référence des Pathologies Gynécologiques Rares et des Maladies Endocriniennes Rares de la Croissance et du Développement, Hôpital Universitaire Necker Enfants Malades, Université de Paris, Paris, France.,Department of Endocrinology, Metabolism and Diabetes, Inserm U1016, Cochin Institute, Paris, France.,Pediatric Endocrinology Department, University of Sao Paulo, Sao Paulo, Brazil
| | - Elisa Giani
- Pediatric Endocrinology, Gynaecology and Diabetology, Centre de Référence des Pathologies Gynécologiques Rares et des Maladies Endocriniennes Rares de la Croissance et du Développement, Hôpital Universitaire Necker Enfants Malades, Université de Paris, Paris, France.,Department of Endocrinology, Metabolism and Diabetes, Inserm U1016, Cochin Institute, Paris, France.,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Laurence Vaivre-Douret
- Faculty of Health, Department of Medicine Paris Descartes, Université de Paris, and Institut Universitaire de France (IUF), Paris, France.,National Institute of Health and Medical Research (INSERM UMR 1018-CESP), Faculty of Medicine, University of Paris-Saclay, UVSQ, Villejuif, France.,Imagine Institute, Paris, France
| | - Dulanjalee Kariyawasam
- Pediatric Endocrinology, Gynaecology and Diabetology, Centre de Référence des Pathologies Gynécologiques Rares et des Maladies Endocriniennes Rares de la Croissance et du Développement, Hôpital Universitaire Necker Enfants Malades, Université de Paris, Paris, France.,Imagine Institute, Paris, France
| | - Marianne Berdugo
- Physiopathology of Ocular Diseases: Therapeutic Innovations, Sorbonne-Université and Université de Paris, Inserm UMRS 1138, Paris, France
| | - Laure Garcin
- Pediatric Endocrinology, Gynaecology and Diabetology, Centre de Référence des Pathologies Gynécologiques Rares et des Maladies Endocriniennes Rares de la Croissance et du Développement, Hôpital Universitaire Necker Enfants Malades, Université de Paris, Paris, France
| | - Jacques Beltrand
- Pediatric Endocrinology, Gynaecology and Diabetology, Centre de Référence des Pathologies Gynécologiques Rares et des Maladies Endocriniennes Rares de la Croissance et du Développement, Hôpital Universitaire Necker Enfants Malades, Université de Paris, Paris, France.,Department of Endocrinology, Metabolism and Diabetes, Inserm U1016, Cochin Institute, Paris, France.,Imagine Institute, Paris, France
| | | | - Michel Polak
- Pediatric Endocrinology, Gynaecology and Diabetology, Centre de Référence des Pathologies Gynécologiques Rares et des Maladies Endocriniennes Rares de la Croissance et du Développement, Hôpital Universitaire Necker Enfants Malades, Université de Paris, Paris, France.,Department of Endocrinology, Metabolism and Diabetes, Inserm U1016, Cochin Institute, Paris, France.,Imagine Institute, Paris, France
| |
Collapse
|