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Razzaghy-Azar M, Saeedi S, Dayani SB, Enayati S, Abbasi F, Hashemian S, Eshraghi P, Karimdadi S, Tajdini P, Vakili R, Amoli MM, Yaghootkar H. Investigating Genetic Mutations in a Large Cohort of Iranian Patients with Congenital Hyperinsulinism. J Clin Res Pediatr Endocrinol 2022; 14:87-95. [PMID: 34927408 PMCID: PMC8900073 DOI: 10.4274/jcrpe.galenos.2021.2021.0071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE Congenital hyperinsulinism (CHI) is the most frequent cause of severe and persistent hypoglycaemia from birth. Understanding the pathophysiology and genetic defects behind hyperinsulinism and its complications provides clues to timely diagnosis and management. The aim of this study was to evaluate the underlying genetic aetiology of a specific Iranian pediatric cohort with CHI. METHODS A total of 44 unrelated children, 20 girls and 24 boys, with an initial diagnosis or history of CHI from all regions of Iran were recruited between 2016 and 2019. Targeted next generation sequencing (tNGS) was performed for the genes found in about half of CHI patients. RESULTS Mutations were identified in 24 cases (55%). Patients with a confirmed genetic cause were mainly diagnosed below age of one year old (p=0.01), had fewer other syndromic features, excluding seizure, (p=0.03), were less diazoxide responsive (p=0.04) and were more diazoxide unresponsive leading to pancreatectomy (p=0.007) compared to those with no identified mutations. Among 24 patients with identified genetic mutations, 17 (71%) had a mutation in ABCC8, 3 (12%) in KCNJ11, 3 (12%) in HADH, and 1 patient had a mutation in KMT2D. These included five novel mutations in ABCC8, KCNJ11, and KMT2D. CONCLUSION This is the biggest genetic study of CHI in Iran. A high frequency of recessive forms of CHI, especially HADH mutations, in our study could be due to a high rate of consanguineous marriage. We recommend tNGS to screen for all the CHI genes.
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Affiliation(s)
- Maryam Razzaghy-Azar
- Tehran University of Medical Sciences, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Metabolic Disorders Research Centre, Tehran, Iran,Iran University of Medical Sciences, H. Aliasghar Hospital, Tehran, Iran
| | - Saeedeh Saeedi
- Tehran University of Medical Sciences, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Metabolic Disorders Research Centre, Tehran, Iran,Tehran University of Medical Sciences, Endocrinology and Metabolism Clinical Sciences Institute, Endocrinology and Metabolism Research Center, Tehran, Iran
| | - Sepideh Borhan Dayani
- Tehran University of Medical Sciences, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Metabolic Disorders Research Centre, Tehran, Iran
| | - Samaneh Enayati
- Tehran University of Medical Sciences, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Metabolic Disorders Research Centre, Tehran, Iran
| | - Farzaneh Abbasi
- Tehran University of Medical Sciences, Children’s Medical Center Hospital, Growth and Development Research Center, Tehran, Iran
| | - Somayyeh Hashemian
- Mashhad University of Medical Sciences, Faculty of Medicine, Akbar Hospital, Department of Pediatric Diseases, Mashhad, Iran
| | - Peyman Eshraghi
- Mashhad University of Medical Sciences, Faculty of Medicine, Akbar Hospital, Department of Pediatric Diseases, Mashhad, Iran
| | - Siroos Karimdadi
- Mashhad University of Medical Sciences, Faculty of Medicine, Akbar Hospital, Department of Pediatric Diseases, Mashhad, Iran
| | - Parisa Tajdini
- Tehran University of Medical Sciences, Children’s Medical Center Hospital, Growth and Development Research Center, Tehran, Iran
| | - Rahim Vakili
- Mashhad University of Medical Sciences, Faculty of Medicine, Akbar Hospital, Department of Pediatric Diseases, Mashhad, Iran
| | - Mahsa M. Amoli
- Tehran University of Medical Sciences, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Metabolic Disorders Research Centre, Tehran, Iran
| | - Hanieh Yaghootkar
- University of Exeter, College of Medicine and Health, Genetics of Complex Traits, London; University of Westminster, School of Life Sciences, Research Centre for Optimal Health, London, England; Luleå University of Technology, Department of Health Sciences, Division of Medical Sciences, Luleå, Sweden,* Address for Correspondence: University of Exeter, College of Medicine and Health, Genetics of Complex Traits, London, England E-mail:
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Haris B, Saraswathi S, Hussain K. Somatostatin analogues for the treatment of hyperinsulinaemic hypoglycaemia. Ther Adv Endocrinol Metab 2020; 11:2042018820965068. [PMID: 33329885 PMCID: PMC7720331 DOI: 10.1177/2042018820965068] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 09/11/2020] [Indexed: 01/10/2023] Open
Abstract
Hyperinsulinaemic hypoglycaemia (HH) is a biochemical finding of low blood glucose levels due to the dysregulation of insulin secretion from pancreatic β-cells. Under normal physiological conditions, glucose metabolism is coupled to β-cell insulin secretion so that blood glucose levels are maintained within the physiological range of 3.5-5.5 mmol/L. However, in HH this coupling of glucose metabolism to insulin secretion is perturbed so that insulin secretion becomes unregulated. HH typically occurs in the neonatal, infancy and childhood periods and can be due to many different causes. Adults can also present with HH but the causes in adults tend to be different. Somatostatin (SST) is a peptide hormone that is released by the delta cells (δ-cells) in the pancreas. It binds to G protein-coupled SST receptors to regulate a variety of location-specific and selective functions such as hormone inhibition, neurotransmission and cell proliferation. SST plays a potent role in the regulation of both insulin and glucagon secretion in response to changes in glucose levels by negative feedback mechanism. The half-life of SST is only 1-3 min due to quick degradation by peptidases in plasma and tissues. Thus, a direct continuous intravenous or subcutaneous infusion is required to achieve the therapeutic effect. These limitations prompted the discovery of SST analogues such as octreotide and lanreotide, which have longer half-lives and therefore can be administered as injections. SST analogues are used to treat different forms of HH in children and adults and therapeutic effect is achieved by suppressing insulin secretion from pancreatic β-cells by complex mechanisms. These treatments are associated with several side effects, especially in the newborn period, with necrotizing enterocolitis being the most serious side effect and hence SS analogues should be used with extreme caution in this age group.
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Affiliation(s)
- Basma Haris
- Department of Paediatric Medicine, Division of Endocrinology, Sidra Medicine, Doha, Qatar
| | - Saras Saraswathi
- Department of Paediatric Medicine, Division of Endocrinology, Sidra Medicine, Doha, Qatar
| | - Khalid Hussain
- Professor of Paediatrics, Weill Cornell Medicine-Qatar, Division Chief – Endocrinology, Department of Paediatric Medicine, Division of Endocrinology, Sidra Medicine, OPC, C6-340 |PO Box 26999, Al Luqta Street, Education City North Campus, Doha, Qatar
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Xu A, Cheng J, Sheng H, Wen Z, Lin Y, Zhou Z, Zeng C, Shao Y, Li C, Liu L, Li X. Clinical Management and Gene Mutation Analysis of Children with Congenital Hyperinsulinism in South China. J Clin Res Pediatr Endocrinol 2019; 11:400-409. [PMID: 31208162 PMCID: PMC6878346 DOI: 10.4274/jcrpe.galenos.2019.2019.0046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To explore the clinical presentation and molecular genetic characteristics of a cohort of congenital hyperinsulinism (CHI) patients from southern China and also to explore the most appropriate therapeutic approaches. METHODS We retrospectively reviewed a cohort of 65 children with CHI. Mutational analysis was performed for KCNJ11 and ABCC8 genes. The GLUD1 gene was sequenced in patients with hyperammonaemia. GCK gene sequencing was performed in those patients with no mutation identified in the ABCC8, KCNJ11 or GLUD1 genes. RESULTS ABCC8 mutations were identified in 16 (25%) of the cohort, GLUD1 mutations were identified in five children, and no KCNJ11 or GCK mutations were identified. Moreover, some unique features of ABCC8 gene mutations in southern Chinese CHI patients were found in this study. The most common mutation was a deletion/insertion mutation p.Thr1042GlnfsX75 was found in five unrelated patients, which possibly represents a relatively common mutation in southern China. Five novel ABCC8 mutations were detected. The mutations were p.Phe5SerfsX72, p.Gln273ArgfsX85, p.Leu724del, p.Asp1447Gly and IVS 25-1G>T. Five compound heterozygous mutations of ABCC8 gene were identified in this study, and three of these patients were diazoxide-responsive. Forty patients were diazoxide-responsive, 13 patients were diazoxide-unresponsive and 12 patients received dietary treatment only. A pancreatectomy was performed in 10 patients who were unresponsive to medical treatment. CONCLUSION To the best of our knowledge, this is the first study of CHI in south China. Mutations in ABCC8 are the most common causes of CHI in this cohort. Diazoxide and dietary treatment were effective in most patients. Multicentre studies are necessary to obtain the long-term follow-up characteristics of such patients at a national level.
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Affiliation(s)
- Aijing Xu
- Guangzhou Women and Children’s Medical Center, Clinic of Genetics and Endocrinology, Guangzhou, China,Contributed equally to this work
| | - Jing Cheng
- Guangzhou Women and Children’s Medical Center, Clinic of Genetics and Endocrinology, Guangzhou, China,Contributed equally to this work
| | - Huiying Sheng
- Guangzhou Women and Children’s Medical Center, Clinic of Genetics and Endocrinology, Guangzhou, China
| | - Zhe Wen
- Guangzhou Women and Children’s Medical Center, Clinic of Pediatric Surgery, Guangzhou, China
| | - Yunting Lin
- Guangzhou Women and Children’s Medical Center, Clinic of Genetics and Endocrinology, Guangzhou, China
| | - Zhihong Zhou
- Guangzhou Women and Children’s Medical Center, Clinic of Genetics and Endocrinology, Guangzhou, China
| | - Chunhua Zeng
- Guangzhou Women and Children’s Medical Center, Clinic of Genetics and Endocrinology, Guangzhou, China
| | - Yongxian Shao
- Guangzhou Women and Children’s Medical Center, Clinic of Genetics and Endocrinology, Guangzhou, China
| | - Cuiling Li
- Guangzhou Women and Children’s Medical Center, Clinic of Genetics and Endocrinology, Guangzhou, China
| | - Li Liu
- Guangzhou Women and Children’s Medical Center, Clinic of Genetics and Endocrinology, Guangzhou, China
| | - Xiuzhen Li
- Guangzhou Women and Children’s Medical Center, Clinic of Genetics and Endocrinology, Guangzhou, China,* Address for Correspondence: Guangzhou Women and Children’s Medical Center, Clinic of Genetics and Endocrinology, Guangzhou, China Phone: +86020-38076127 E-mail:
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Galcheva S, Demirbilek H, Al-Khawaga S, Hussain K. The Genetic and Molecular Mechanisms of Congenital Hyperinsulinism. Front Endocrinol (Lausanne) 2019; 10:111. [PMID: 30873120 PMCID: PMC6401612 DOI: 10.3389/fendo.2019.00111] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 02/06/2019] [Indexed: 12/13/2022] Open
Abstract
Congenital hyperinsulinism (CHI) is a heterogenous and complex disorder in which the unregulated insulin secretion from pancreatic beta-cells leads to hyperinsulinaemic hypoglycaemia. The severity of hypoglycaemia varies depending on the underlying molecular mechanism and genetic defects. The genetic and molecular causes of CHI include defects in pivotal pathways regulating the secretion of insulin from the beta-cell. Broadly these genetic defects leading to unregulated insulin secretion can be grouped into four main categories. The first group consists of defects in the pancreatic KATP channel genes (ABCC8 and KCNJ11). The second and third categories of conditions are enzymatic defects (such as GDH, GCK, HADH) and defects in transcription factors (for example HNF1α, HNF4α) leading to changes in nutrient flux into metabolic pathways which converge on insulin secretion. Lastly, a large number of genetic syndromes are now linked to hyperinsulinaemic hypoglycaemia. As the molecular and genetic basis of CHI has expanded over the last few years, this review aims to provide an up-to-date knowledge on the genetic causes of CHI.
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Affiliation(s)
- Sonya Galcheva
- Department of Paediatrics, University Hospital St. Marina, Varna Medical University, Varna, Bulgaria
| | - Hüseyin Demirbilek
- Department of Paediatric Endocrinology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Sara Al-Khawaga
- Division of Endocrinology, Department of Paediatric Medicine, Sidra Medicine, Doha, Qatar
| | - Khalid Hussain
- Division of Endocrinology, Department of Paediatric Medicine, Sidra Medicine, Doha, Qatar
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Bohnen MS, Ma L, Zhu N, Qi H, McClenaghan C, Gonzaga-Jauregui C, Dewey FE, Overton JD, Reid JG, Shuldiner AR, Baras A, Sampson KJ, Bleda M, Hadinnapola C, Haimel M, Bogaard HJ, Church C, Coghlan G, Corris PA, Eyries M, Gibbs JSR, Girerd B, Houweling AC, Humbert M, Guignabert C, Kiely DG, Lawrie A, MacKenzie Ross RV, Martin JM, Montani D, Peacock AJ, Pepke-Zaba J, Soubrier F, Suntharalingam J, Toshner M, Treacy CM, Trembath RC, Vonk Noordegraaf A, Wharton J, Wilkins MR, Wort SJ, Yates K, Gräf S, Morrell NW, Krishnan U, Rosenzweig EB, Shen Y, Nichols CG, Kass RS, Chung WK. Loss-of-Function ABCC8 Mutations in Pulmonary Arterial Hypertension. CIRCULATION. GENOMIC AND PRECISION MEDICINE 2018; 11:e002087. [PMID: 30354297 PMCID: PMC6206877 DOI: 10.1161/circgen.118.002087] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 08/01/2018] [Indexed: 11/16/2022]
Abstract
BACKGROUND In pulmonary arterial hypertension (PAH), pathological changes in pulmonary arterioles progressively raise pulmonary artery pressure and increase pulmonary vascular resistance, leading to right heart failure and high mortality rates. Recently, the first potassium channelopathy in PAH, because of mutations in KCNK3, was identified as a genetic cause and pharmacological target. METHODS Exome sequencing was performed to identify novel genes in a cohort of 99 pediatric and 134 adult-onset group I PAH patients. Novel rare variants in the gene identified were independently identified in a cohort of 680 adult-onset patients. Variants were expressed in COS cells and function assessed by patch-clamp and rubidium flux analysis. RESULTS We identified a de novo novel heterozygous predicted deleterious missense variant c.G2873A (p.R958H) in ABCC8 in a child with idiopathic PAH. We then evaluated all individuals in the original and a second cohort for rare or novel variants in ABCC8 and identified 11 additional heterozygous predicted damaging ABCC8 variants. ABCC8 encodes SUR1 (sulfonylurea receptor 1)-a regulatory subunit of the ATP-sensitive potassium channel. We observed loss of ATP-sensitive potassium channel function for all ABCC8 variants evaluated and pharmacological rescue of all channel currents in vitro by the SUR1 activator, diazoxide. CONCLUSIONS Novel and rare missense variants in ABCC8 are associated with PAH. Identified ABCC8 mutations decreased ATP-sensitive potassium channel function, which was pharmacologically recovered.
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Affiliation(s)
- Michael S. Bohnen
- Dept of Pharmacology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Lijiang Ma
- Dept of Pediatrics, College of Physicians & Surgeons, Columbia University, New York, NY
| | - Na Zhu
- Dept of Pediatrics, College of Physicians & Surgeons, Columbia University, New York, NY
- Dept of Systems Biology, Columbia University, New York, NY
| | - Hongjian Qi
- Dept of Applied Physics & Applied Mathematics, Columbia University, New York, NY
- Dept of Systems Biology, Columbia University, New York, NY
| | - Conor McClenaghan
- Dept of Cell Biology & Physiology, and the Centre for the Investigation of Membrane Excitability Diseases, Washington University School of Medicine, Washington University in St Louis, St Louis, MO
| | | | | | - John D. Overton
- Regeneron Genetics Center, Regeneron Pharmaceuticals Inc. Tarrytown, NY
| | - Jeffrey G. Reid
- Regeneron Genetics Center, Regeneron Pharmaceuticals Inc. Tarrytown, NY
| | - Alan R. Shuldiner
- Regeneron Genetics Center, Regeneron Pharmaceuticals Inc. Tarrytown, NY
| | - Aris Baras
- Regeneron Genetics Center, Regeneron Pharmaceuticals Inc. Tarrytown, NY
| | - Kevin J. Sampson
- Dept of Pharmacology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Marta Bleda
- Dept of Medicine, University of Cambridge, Addenbrookes Hospital, Hills Road, Cambridge, United Kingdom
| | - Charaka Hadinnapola
- Dept of Medicine, University of Cambridge, Addenbrookes Hospital, Hills Road, Cambridge, United Kingdom
| | - Matthias Haimel
- Dept of Medicine, University of Cambridge, Addenbrookes Hospital, Hills Road, Cambridge, United Kingdom
| | | | - Colin Church
- Golden Jubilee National Hospital, Glasgow, Scotland
| | | | - Paul A. Corris
- Newcastle University & The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, United Kingdom
| | - Mélanie Eyries
- Dépt de génétique, hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and UMR_S 1166-ICAN, INSERM, UPMC Sorbonne Universités, Paris, France
| | - J. Simon R. Gibbs
- National Heart & Lung Institute, Imperial College London, United Kingdom
| | - Barbara Girerd
- Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay, AP-HP, Centre de référence de l’hypertension pulmonaire sévère, INSERM UMR_S 999, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | | | - Marc Humbert
- Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay, AP-HP, Centre de référence de l’hypertension pulmonaire sévère, INSERM UMR_S 999, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | - Christophe Guignabert
- Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay, AP-HP, Centre de référence de l’hypertension pulmonaire sévère, INSERM UMR_S 999, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | | | - Allan Lawrie
- Dept of Infection, Immunity & Cardiovascular Disease, University of Sheffield
| | | | - Jennifer M. Martin
- Dept of Medicine, University of Cambridge, Addenbrookes Hospital, Hills Road, Cambridge, United Kingdom
| | - David Montani
- Université Paris-Sud, Faculté de Médecine, Université Paris-Saclay, AP-HP, Centre de référence de l’hypertension pulmonaire sévère, INSERM UMR_S 999, Hôpital Bicêtre, Le Kremlin-Bicêtre, France
| | | | | | - Florent Soubrier
- Dépt de génétique, hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, and UMR_S 1166-ICAN, INSERM, UPMC Sorbonne Universités, Paris, France
| | | | - Mark Toshner
- Dept of Medicine, University of Cambridge, Addenbrookes Hospital, Hills Road, Cambridge, United Kingdom
- Papworth Hospital, Cambridge
| | - Carmen M. Treacy
- Dept of Medicine, University of Cambridge, Addenbrookes Hospital, Hills Road, Cambridge, United Kingdom
| | - Richard C. Trembath
- Division of Genetics & Molecular Medicine, King’s College, London, Hammersmith Campus, London
| | | | - John Wharton
- Dept of Medicine, Imperial College London, Hammersmith Campus, London
| | - Martin R. Wilkins
- Dept of Medicine, Imperial College London, Hammersmith Campus, London
| | - Stephen J. Wort
- National Heart & Lung Institute, Imperial College London, United Kingdom
- Royal Brompton Hospital, London, United Kingdom
| | - Katherine Yates
- Dept of Medicine, University of Cambridge, Addenbrookes Hospital, Hills Road, Cambridge, United Kingdom
| | - Stefan Gräf
- Dept of Medicine, University of Cambridge, Addenbrookes Hospital, Hills Road, Cambridge, United Kingdom
- Dept of Haematology, University of Cambridge, Addenbrookes Hospital, Hills Road, Cambridge, United Kingdom
| | - Nicholas W. Morrell
- Dept of Medicine, University of Cambridge, Addenbrookes Hospital, Hills Road, Cambridge, United Kingdom
| | - Usha Krishnan
- Dept of Pediatrics, College of Physicians & Surgeons, Columbia University, New York, NY
| | - Erika B. Rosenzweig
- Dept of Pediatrics, College of Physicians & Surgeons, Columbia University, New York, NY
| | - Yufeng Shen
- Dept of Applied Physics & Applied Mathematics, Columbia University, New York, NY
- Dept of Systems Biology, Columbia University, New York, NY
| | - Colin G. Nichols
- Dept of Cell Biology & Physiology, and the Centre for the Investigation of Membrane Excitability Diseases, Washington University School of Medicine, Washington University in St Louis, St Louis, MO
| | - Robert S. Kass
- Dept of Pharmacology, College of Physicians and Surgeons, Columbia University, New York, NY
| | - Wendy K. Chung
- Dept of Pediatrics, College of Physicians & Surgeons, Columbia University, New York, NY
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John CM, Agarwal P, Govindarajulu S, Sundaram S, Senniappan S. Congenital hyperinsulinism: diagnostic and management challenges in a developing country - case report. Ann Pediatr Endocrinol Metab 2017; 22:272-275. [PMID: 29301189 PMCID: PMC5769830 DOI: 10.6065/apem.2017.22.4.272] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 04/06/2017] [Accepted: 04/21/2017] [Indexed: 11/30/2022] Open
Abstract
Management of congenital hyperinsulinemia of infancy (CHI) is challenging. A 4-month-old female infant with persistent hypoglycemia and elevated insulin levels was diagnosed with CHI. Gallium-68 DOTANOC positron emission tomography/computed tomography (PET/CT) scan (68Ga-labeled [1,4,7,10-tetraazacyclododecane-N,N',N'',N'''-tetraacetic acid]-1-NaI3-octreotide) demonstrated focal disease in the body of the pancreas. Genetic studies indicated paternal inheritance, making focal disease likely. She was started on diazoxide therapy with partial improvement in blood glucose levels. Due to a suboptimal response to diazoxide and the likelihood of focal disease amenable to surgery, a laparoscopic subtotal pancreatectomy with preservation of the head of the pancreas was performed. The biopsy demonstrated diffuse hyperplastic pancreatic islet cells on immunohistochemistry, indicative of diffuse rather than focal disease. Paternal inheritance is a recognized indicator of focal disease. Gallium-68 DOTANOC PET/CT scan is the only available imaging modality in South India as 18F-L-dihydroxyphenylalanine (DOPA) PET/CT scan is not available at present. A laparoscopic approach reduces the postoperative recovery time and morbidity in such patients. The absence of 18F-L-DOPA PET/CT scan and the limited supply of diazoxide makes the management of this complex condition more challenging in developing countries.
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Affiliation(s)
- Cheri Mathews John
- Angels Speciality Clinic, Chennai, India,Address for correspondence: Cheri Mathews John, DCH, FRCPCHhttps://orcid.org/0000-0003-3066-7423 Angels Speciality Clinic, AL-190, 1st street, 12th Main Road, Anna Nagar, Chennai 600040, India Tel: +91-9840362658 Fax: +91-9840362658 E-mail:
| | - Prakash Agarwal
- Department of Paediatric Surgery, Sri Ramachandra University, Chennai, India
| | | | - Sandhya Sundaram
- Department of Pathology, Sri Ramachandra University, Chennai, India
| | - Senthil Senniappan
- Department of Paediatric Endocrinology, Alder Hey Children’s Hospital, Liverpool, UK
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Alaei MR, Akbaroghli S, Keramatipour M, Alaei A. A Case Series: Congenital Hyperinsulinism. Int J Endocrinol Metab 2016; 14:e37311. [PMID: 28123437 PMCID: PMC5237296 DOI: 10.5812/ijem.37311] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 08/22/2016] [Accepted: 09/05/2016] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Congenital hyperinsulinism is a rare inherited disease caused by mutations in genes responsible for β-cell's function in glucose hemostasis leading to profound and recurrent hypoglycemia. The incidence of the disease is about 1 in 50000 newborns. Mutations in at least 8 genes have been reported to cause congenital hyperinsulinism. Mutations in ABCC8 gene are the most common cause of the disease that account for approximately 40% of cases. Less frequently KCNJ11 gene mutations are responsible for the disease. Mutations in other genes such as HADH account for smaller fractions of cases. In nearly half of the cases the cause remains unknown. CASE PRESENTATION During the period between 2005 and 2010, a total of six patients with persistent hyperinsulinism were investigated at Mofid Children's Hospital. In this study all of the patients had early onset hyperinsulinemia. Five patients had consanguineous parents. After failure of medical treatment in three patients, They were undergone pancreatectomy. Two diffuse types and one focal type had been recognized in pathological analysis of intra-operative frozen specimens of pancreas in these patients. Genetic analysis was performed using polymerase chain reaction followed by Sanger sequencing for ABCC8, KCNJ11and HADH genes. In five patients homozygous mutations in these genes were identified that indicated an autosomal recessive pattern of inheritance. In one patient a heterozygous mutation in ABCC8 was identified, indicating possible autosomal dominant inheritance of the disease. CONCLUSIONS Congenital hyperinsulinism can have different inheritance pattern. Autosomal recessive inheritance is more common but less frequently autosomal dominant inheritance can be seen. It appears that mutations in ABCC8 gene can show both autosomal recessive and autosomal dominant inheritance of the disease. PCR followed by Sanger sequencing proved to be an efficient method for mutation detection in three investigated genes. Despite early diagnosis, psychomotor retardation was seen in two patients.
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Affiliation(s)
- Mohammad Reza Alaei
- Department of Pediatric Endocrinology, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
| | - Susan Akbaroghli
- Genetic Counseling Division, Mofid Children’s Hospital, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Susan Akbaroghli, Mofid Children’s Hospital, Tehran, IR Iran. Tel: +98-2122227033, Fax: +98-2122227033, E-mail:
| | - Mohammad Keramatipour
- Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Ali Alaei
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
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