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Saneifard H, Hajihashemi E, Fallahi M. Clinical Course and Outcome in Children with Congenital Hyperinsulinism. ARCHIVES OF IRANIAN MEDICINE 2022; 25:422-427. [DOI: 10.34172/aim.2022.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/07/2021] [Indexed: 11/06/2022]
Abstract
Background: Hyperinsulinism is the most common cause of persistent or recurrent neonatal hypoglycemia that may result in neurological deficits. The treatment goal in these patients is prevention of hypoglycemia to decrease mortality and morbidity. This study was done to determine the clinical course and outcome in children with congenital hyperinsulinism (CHI) referring to Mofid Children’s Hospital from 2011 to 2017. Methods: This study was done on 22 children with CHI referring to Mofid Children’s Hospital from 2011 to 2017. The demographic, perinatal, clinical, laboratory, imaging, pharmacological, treatment and follow up data of these children were collected and analyzed. Results: Among 22 children with CHI, the mortality rate was higher among those who received hydrocortisone versus those who did not receive hydrocortisone (46% versus 40%). Conclusion: According to the results of this study, hydrocortisone had a negative impact on the outcomes of these children, which is important in the management of hypoglycemia. The clinical course and outcome of children with CHI was better with medical compared to surgical treatment.
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Affiliation(s)
| | - Elham Hajihashemi
- Pediatric Department, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Minoo Fallahi
- Neonatal Health Research Center, Research Institute for Children Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Gϋemes M, Rahman SA, Kapoor RR, Flanagan S, Houghton JAL, Misra S, Oliver N, Dattani MT, Shah P. Hyperinsulinemic hypoglycemia in children and adolescents: Recent advances in understanding of pathophysiology and management. Rev Endocr Metab Disord 2020; 21:577-597. [PMID: 32185602 PMCID: PMC7560934 DOI: 10.1007/s11154-020-09548-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Hyperinsulinemic hypoglycemia (HH) is characterized by unregulated insulin release, leading to persistently low blood glucose concentrations with lack of alternative fuels, which increases the risk of neurological damage in these patients. It is the most common cause of persistent and recurrent hypoglycemia in the neonatal period. HH may be primary, Congenital HH (CHH), when it is associated with variants in a number of genes implicated in pancreatic development and function. Alterations in fifteen genes have been recognized to date, being some of the most recently identified mutations in genes HK1, PGM1, PMM2, CACNA1D, FOXA2 and EIF2S3. Alternatively, HH can be secondary when associated with syndromes, intra-uterine growth restriction, maternal diabetes, birth asphyxia, following gastrointestinal surgery, amongst other causes. CHH can be histologically characterized into three groups: diffuse, focal or atypical. Diffuse and focal forms can be determined by scanning using fluorine-18 dihydroxyphenylalanine-positron emission tomography. Newer and improved isotopes are currently in development to provide increased diagnostic accuracy in identifying lesions and performing successful surgical resection with the ultimate aim of curing the condition. Rapid diagnostics and innovative methods of management, including a wider range of treatment options, have resulted in a reduction in co-morbidities associated with HH with improved quality of life and long-term outcomes. Potential future developments in the management of this condition as well as pathways to transition of the care of these highly vulnerable children into adulthood will also be discussed.
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Affiliation(s)
- Maria Gϋemes
- Genetics and Genomic Medicine Programme, UCL Great Ormond Street Institute of Child Health, Great Ormond Street, London, WC1N 3JH, UK
- Department of Pediatric Endocrinology, Great Ormond Street Hospital for Children, London, UK
- Endocrinology Service, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Sofia Asim Rahman
- Genetics and Genomic Medicine Programme, UCL Great Ormond Street Institute of Child Health, Great Ormond Street, London, WC1N 3JH, UK
| | - Ritika R Kapoor
- Pediatric Diabetes and Endocrinology, King's College Hospital NHS Trust, Denmark Hill, London, UK
| | - Sarah Flanagan
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
| | - Jayne A L Houghton
- Institute of Biomedical and Clinical Science, University of Exeter Medical School, Exeter, UK
- Royal Devon and Exeter Foundation Trust, Exeter, UK
| | - Shivani Misra
- Department of Diabetes, Endocrinology and Metabolic Medicine, Faculty of Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Nick Oliver
- Department of Diabetes, Endocrinology and Metabolic Medicine, Faculty of Medicine, Imperial College Healthcare NHS Trust, London, UK
| | - Mehul Tulsidas Dattani
- Genetics and Genomic Medicine Programme, UCL Great Ormond Street Institute of Child Health, Great Ormond Street, London, WC1N 3JH, UK
- Department of Pediatric Endocrinology, Great Ormond Street Hospital for Children, London, UK
| | - Pratik Shah
- Genetics and Genomic Medicine Programme, UCL Great Ormond Street Institute of Child Health, Great Ormond Street, London, WC1N 3JH, UK.
- Department of Pediatric Endocrinology, Great Ormond Street Hospital for Children, London, UK.
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Craigie RJ, Salomon-Estebanez M, Yau D, Han B, Mal W, Newbould M, Cheesman E, Bitetti S, Mohamed Z, Sajjan R, Padidela R, Skae M, Flanagan S, Ellard S, Cosgrove KE, Banerjee I, Dunne MJ. Clinical Diversity in Focal Congenital Hyperinsulinism in Infancy Correlates With Histological Heterogeneity of Islet Cell Lesions. Front Endocrinol (Lausanne) 2018; 9:619. [PMID: 30386300 PMCID: PMC6199412 DOI: 10.3389/fendo.2018.00619] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 09/27/2018] [Indexed: 01/11/2023] Open
Abstract
Background: Congenital Hyperinsulinism (CHI) is an important cause of severe and persistent hypoglycaemia in infancy and childhood. The focal form (CHI-F) of CHI can be potentially cured by pancreatic lesionectomy. While diagnostic characteristics of CHI-F pancreatic histopathology are well-recognized, correlation with clinical phenotype has not been established. Aims: We aimed to correlate the diversity in clinical profiles of patients with islet cell organization in CHI-F pancreatic tissue. Methods: Clinical datasets were obtained from 25 patients with CHI-F due to ABCC8/KCNJ11 mutations. 18F-DOPA PET-CT was used to localize focal lesions prior to surgery. Immunohistochemistry was used to support protein expression studies. Results: In 28% (n = 7) of patient tissues focal lesions were amorphous and projected into adjoining normal pancreatic tissue without clear delineation from normal tissue. In these cases, severe hypoglycaemia was detected within, on average, 2.8 ± 0.8 (range 1-7) days following birth. By contrast, in 72% (n = 18) of tissues focal lesions were encapsulated within a defined matrix capsule. In this group, the onset of severe hypoglycaemia was generally delayed; on average 46.6 ± 14.3 (range 1-180) days following birth. For patients with encapsulated lesions and later-onset hypoglycaemia, we found that surgical procedures were curative and less complex. Conclusion: CHI-F is associated with heterogeneity in the organization of focal lesions, which correlates well with clinical presentation and surgical outcomes.
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Affiliation(s)
- Ross J. Craigie
- Paediatric Surgery, Royal Manchester Children's Hospital, University Manchester NHS Foundation Trust (MFT), Manchester, United Kingdom
| | - Maria Salomon-Estebanez
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, United Kingdom
- Paediatric Endocrinology, Royal Manchester Children's Hospital, University Manchester NHS Foundation Trust (MFT), Manchester, United Kingdom
| | - Daphne Yau
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, United Kingdom
- Paediatric Endocrinology, Royal Manchester Children's Hospital, University Manchester NHS Foundation Trust (MFT), Manchester, United Kingdom
| | - Bing Han
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, United Kingdom
| | - Walaa Mal
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, United Kingdom
| | - Melanie Newbould
- Paediatric Histopathology, Royal Manchester Children's Hospital, University Manchester NHS Foundation Trust (MFT), Manchester, United Kingdom
| | - Edmund Cheesman
- Paediatric Histopathology, Royal Manchester Children's Hospital, University Manchester NHS Foundation Trust (MFT), Manchester, United Kingdom
| | - Stefania Bitetti
- Paediatric Histopathology, Royal Manchester Children's Hospital, University Manchester NHS Foundation Trust (MFT), Manchester, United Kingdom
| | - Zainab Mohamed
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, United Kingdom
- Paediatric Endocrinology, Royal Manchester Children's Hospital, University Manchester NHS Foundation Trust (MFT), Manchester, United Kingdom
| | - Rakesh Sajjan
- Nuclear Medicine, Royal Manchester Children's Hospital, University Manchester NHS Foundation Trust (MFT), Manchester, United Kingdom
| | - Raja Padidela
- Paediatric Endocrinology, Royal Manchester Children's Hospital, University Manchester NHS Foundation Trust (MFT), Manchester, United Kingdom
| | - Mars Skae
- Paediatric Endocrinology, Royal Manchester Children's Hospital, University Manchester NHS Foundation Trust (MFT), Manchester, United Kingdom
| | - Sarah Flanagan
- Molecular Genetics, Royal Devon & Exeter NHS Foundation Trust, University of Exeter Medical School, Royal Devon & Exeter Hospital, Exeter, United Kingdom
| | - Sian Ellard
- Molecular Genetics, Royal Devon & Exeter NHS Foundation Trust, University of Exeter Medical School, Royal Devon & Exeter Hospital, Exeter, United Kingdom
| | - Karen E. Cosgrove
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, United Kingdom
| | - Indraneel Banerjee
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, United Kingdom
- Paediatric Endocrinology, Royal Manchester Children's Hospital, University Manchester NHS Foundation Trust (MFT), Manchester, United Kingdom
| | - Mark J. Dunne
- Faculty of Biology, Medicine & Health, University of Manchester, Manchester, United Kingdom
- *Correspondence: Mark J. Dunne
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