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Kaiser JR, Amatya S, Burke RJ, Corr TE, Darwish N, Gandhi CK, Gasda A, Glass KM, Kresch MJ, Mahdally SM, McGarvey MT, Mola SJ, Murray YL, Nissly K, Santiago-Aponte NM, Valencia JC, Palmer TW. Proposed Screening for Congenital Hyperinsulinism in Newborns: Perspective from a Neonatal-Perinatal Medicine Group. J Clin Med 2024; 13:2953. [PMID: 38792494 PMCID: PMC11122587 DOI: 10.3390/jcm13102953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024] Open
Abstract
This perspective work by academic neonatal providers is written specifically for the audience of newborn care providers and neonatologists involved in neonatal hypoglycemia screening. Herein, we propose adding a screen for congenital hyperinsulinism (CHI) by measuring glucose and ketone (i.e., β-hydroxybutyrate (BOHB)) concentrations just prior to newborn hospital discharge and as close to 48 h after birth as possible, at the same time that the mandated state Newborn Dried Blood Spot Screen is obtained. In the proposed protocol, we do not recommend specific metabolite cutoffs, as our primary objective is to simply highlight the concept of screening for CHI in newborns to newborn caregivers. The premise for our proposed screen is based on the known effect of hyperinsulinism in suppressing ketogenesis, thereby limiting ketone production. We will briefly discuss genetic CHI, other forms of neonatal hypoglycemia, and their shared mechanisms; the mechanism of insulin regulation by functional pancreatic islet cell membrane KATP channels; adverse neurodevelopmental sequelae and brain injury due to missing or delaying the CHI diagnosis; the principles of a good screening test; how current neonatal hypoglycemia screening programs do not fulfill the criteria for being effective screening tests; and our proposed algorithm for screening for CHI in newborns.
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Affiliation(s)
- Jeffrey R. Kaiser
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Health Children’s Hospital, Hershey, PA 17033, USA; (S.A.); (R.J.B.); (T.E.C.); (N.D.); (C.K.G.); (A.G.); (K.M.G.); (M.J.K.); (S.M.M.); (M.T.M.); (S.J.M.); (Y.L.M.); (K.N.); (N.M.S.-A.); (J.C.V.); (T.W.P.)
- Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, PA 17033, USA
| | - Shaili Amatya
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Health Children’s Hospital, Hershey, PA 17033, USA; (S.A.); (R.J.B.); (T.E.C.); (N.D.); (C.K.G.); (A.G.); (K.M.G.); (M.J.K.); (S.M.M.); (M.T.M.); (S.J.M.); (Y.L.M.); (K.N.); (N.M.S.-A.); (J.C.V.); (T.W.P.)
| | - Rebecca J. Burke
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Health Children’s Hospital, Hershey, PA 17033, USA; (S.A.); (R.J.B.); (T.E.C.); (N.D.); (C.K.G.); (A.G.); (K.M.G.); (M.J.K.); (S.M.M.); (M.T.M.); (S.J.M.); (Y.L.M.); (K.N.); (N.M.S.-A.); (J.C.V.); (T.W.P.)
| | - Tammy E. Corr
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Health Children’s Hospital, Hershey, PA 17033, USA; (S.A.); (R.J.B.); (T.E.C.); (N.D.); (C.K.G.); (A.G.); (K.M.G.); (M.J.K.); (S.M.M.); (M.T.M.); (S.J.M.); (Y.L.M.); (K.N.); (N.M.S.-A.); (J.C.V.); (T.W.P.)
| | - Nada Darwish
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Health Children’s Hospital, Hershey, PA 17033, USA; (S.A.); (R.J.B.); (T.E.C.); (N.D.); (C.K.G.); (A.G.); (K.M.G.); (M.J.K.); (S.M.M.); (M.T.M.); (S.J.M.); (Y.L.M.); (K.N.); (N.M.S.-A.); (J.C.V.); (T.W.P.)
| | - Chintan K. Gandhi
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Health Children’s Hospital, Hershey, PA 17033, USA; (S.A.); (R.J.B.); (T.E.C.); (N.D.); (C.K.G.); (A.G.); (K.M.G.); (M.J.K.); (S.M.M.); (M.T.M.); (S.J.M.); (Y.L.M.); (K.N.); (N.M.S.-A.); (J.C.V.); (T.W.P.)
| | - Adrienne Gasda
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Health Children’s Hospital, Hershey, PA 17033, USA; (S.A.); (R.J.B.); (T.E.C.); (N.D.); (C.K.G.); (A.G.); (K.M.G.); (M.J.K.); (S.M.M.); (M.T.M.); (S.J.M.); (Y.L.M.); (K.N.); (N.M.S.-A.); (J.C.V.); (T.W.P.)
| | - Kristen M. Glass
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Health Children’s Hospital, Hershey, PA 17033, USA; (S.A.); (R.J.B.); (T.E.C.); (N.D.); (C.K.G.); (A.G.); (K.M.G.); (M.J.K.); (S.M.M.); (M.T.M.); (S.J.M.); (Y.L.M.); (K.N.); (N.M.S.-A.); (J.C.V.); (T.W.P.)
| | - Mitchell J. Kresch
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Health Children’s Hospital, Hershey, PA 17033, USA; (S.A.); (R.J.B.); (T.E.C.); (N.D.); (C.K.G.); (A.G.); (K.M.G.); (M.J.K.); (S.M.M.); (M.T.M.); (S.J.M.); (Y.L.M.); (K.N.); (N.M.S.-A.); (J.C.V.); (T.W.P.)
| | - Sarah M. Mahdally
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Health Children’s Hospital, Hershey, PA 17033, USA; (S.A.); (R.J.B.); (T.E.C.); (N.D.); (C.K.G.); (A.G.); (K.M.G.); (M.J.K.); (S.M.M.); (M.T.M.); (S.J.M.); (Y.L.M.); (K.N.); (N.M.S.-A.); (J.C.V.); (T.W.P.)
| | - Maria T. McGarvey
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Health Children’s Hospital, Hershey, PA 17033, USA; (S.A.); (R.J.B.); (T.E.C.); (N.D.); (C.K.G.); (A.G.); (K.M.G.); (M.J.K.); (S.M.M.); (M.T.M.); (S.J.M.); (Y.L.M.); (K.N.); (N.M.S.-A.); (J.C.V.); (T.W.P.)
| | - Sara J. Mola
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Health Children’s Hospital, Hershey, PA 17033, USA; (S.A.); (R.J.B.); (T.E.C.); (N.D.); (C.K.G.); (A.G.); (K.M.G.); (M.J.K.); (S.M.M.); (M.T.M.); (S.J.M.); (Y.L.M.); (K.N.); (N.M.S.-A.); (J.C.V.); (T.W.P.)
| | - Yuanyi L. Murray
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Health Children’s Hospital, Hershey, PA 17033, USA; (S.A.); (R.J.B.); (T.E.C.); (N.D.); (C.K.G.); (A.G.); (K.M.G.); (M.J.K.); (S.M.M.); (M.T.M.); (S.J.M.); (Y.L.M.); (K.N.); (N.M.S.-A.); (J.C.V.); (T.W.P.)
| | - Katie Nissly
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Health Children’s Hospital, Hershey, PA 17033, USA; (S.A.); (R.J.B.); (T.E.C.); (N.D.); (C.K.G.); (A.G.); (K.M.G.); (M.J.K.); (S.M.M.); (M.T.M.); (S.J.M.); (Y.L.M.); (K.N.); (N.M.S.-A.); (J.C.V.); (T.W.P.)
| | - Nanyaly M. Santiago-Aponte
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Health Children’s Hospital, Hershey, PA 17033, USA; (S.A.); (R.J.B.); (T.E.C.); (N.D.); (C.K.G.); (A.G.); (K.M.G.); (M.J.K.); (S.M.M.); (M.T.M.); (S.J.M.); (Y.L.M.); (K.N.); (N.M.S.-A.); (J.C.V.); (T.W.P.)
| | - Jazmine C. Valencia
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Health Children’s Hospital, Hershey, PA 17033, USA; (S.A.); (R.J.B.); (T.E.C.); (N.D.); (C.K.G.); (A.G.); (K.M.G.); (M.J.K.); (S.M.M.); (M.T.M.); (S.J.M.); (Y.L.M.); (K.N.); (N.M.S.-A.); (J.C.V.); (T.W.P.)
| | - Timothy W. Palmer
- Department of Pediatrics, Division of Neonatal-Perinatal Medicine, Penn State Health Children’s Hospital, Hershey, PA 17033, USA; (S.A.); (R.J.B.); (T.E.C.); (N.D.); (C.K.G.); (A.G.); (K.M.G.); (M.J.K.); (S.M.M.); (M.T.M.); (S.J.M.); (Y.L.M.); (K.N.); (N.M.S.-A.); (J.C.V.); (T.W.P.)
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Hui P, Chen C, Sang Y. Congenital hyperinsulinism patient with ABCC8 and KCNJ11 double heterozygous variants: a case report with 6 years follow-up. J Pediatr Endocrinol Metab 2024; 37:189-191. [PMID: 38154043 DOI: 10.1515/jpem-2023-0445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/11/2023] [Indexed: 12/30/2023]
Affiliation(s)
- Peipei Hui
- Department of Pediatrics, The Affiliated Hospital of Xuzhou Medical College, Xuzhou Medical College, Xuzhou, China
| | - Congli Chen
- Department of Pediatric Endocrinology, Genetic, and Metabolism, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Yanmei Sang
- Department of Pediatric Endocrinology, Genetic, and Metabolism, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
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Yukina M, Solodovnikova E, Popov S, Zakharova V, Utkina M, Petrov V, Troshina E, Mokrysheva N. Clinical Case Report of Non-Diabetic Hypoglycemia Due to a Combination of Germline Mutations in the MEN1 and ABCC8 Genes. Genes (Basel) 2023; 14:1952. [PMID: 37895301 PMCID: PMC10606354 DOI: 10.3390/genes14101952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/13/2023] [Accepted: 10/15/2023] [Indexed: 10/29/2023] Open
Abstract
INTRODUCTION Non-diabetic hypoglycemia (NDH) is a collective term including the multiple causes of hypoglycemic syndrome not due to diabetes mellitus. NDH may result from insulinoma, IGF-2-omas, hypocorticism, Hirata's disease, genital disorders of glucose metabolism, etc. One of the most common causes of NDH faced by an endocrinologist is insulinoma, which in turn can be part of the hereditary syndrome of multiple endocrine neoplasia type 1 (MEN1). Congenital disorders of glucose metabolism in adult patients, on the contrary, are diagnosed extremely rarely, since they usually manifest in childhood. This article presents a unique clinical case of a patient with NDH and genetically verified MEN1 in combination with congenital hyperinsulinism due to an ABCC8 gene mutation. CASE REPORT A 43-year-old patient with hypoglycemic symptoms from childhood is presented, in whom multiple pancreatic tumors and fluctuations in glycemia from 38.7 mg/dL to 329.7 mg/dL (2.15 to 18.3 mmol/L) were detected in adulthood, but a mild course of hypoglycemic syndrome was noted. Numerous examinations that were performed to establish an accurate diagnosis are described, signs that served as a reason for expanding the complex of studies are indicated, possible pathogenetic mechanisms of the mild course of hypoglycemic syndrome and hyperglycemic conditions are discussed. CONCLUSION This case report is original and highlights that we must always remain intolerant of the inexplicable. Conducting an extended gene study can help perform a correct diagnosis in complex cases.
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Affiliation(s)
- Marina Yukina
- State Scientific Center of the Russian Federation Federal State Budgetary Institution, National Medical Research Center of Endocrinology of the Ministry of Health of the Russian Federation, 117036 Moscow, Russia
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