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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Nuralieva N, Yukina M, Sozaeva L, Donnikov M, Kovalenko L, Troshina E, Orlova E, Gryadunov D, Savvateeva E, Dedov I. Diagnostic Accuracy of Methods for Detection of Antibodies against Type I Interferons in Patients with Endocrine Disorders. J Pers Med 2022; 12:jpm12121948. [PMID: 36556169 PMCID: PMC9783777 DOI: 10.3390/jpm12121948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 11/21/2022] [Accepted: 11/22/2022] [Indexed: 11/25/2022] Open
Abstract
Autoantibodies against type 1 interferons (IFN-I) are a highly specific marker for type 1 autoimmune polyglandular syndrome (APS-1). Moreover, determination of antibodies to omega-interferon (IFN-ω) and alpha2-interferon (IFN-α2) allows a short-term diagnosis in patients with isolated and atypical forms of APS-1. In this study, a comparison of three different methods, namely multiplex microarray-based, cell-based and enzyme-linked immunosorbent assays for detection of antibodies against omega-interferon and alpha2-interferon, was carried out. A total of 206 serum samples from adult patients with APS-1, APS-2, isolated autoimmune endocrine pathologies or non-autoimmune endocrine disorders, and healthy individuals were analyzed. In the APS-1 patient cohort (n = 18), there was good agreement between the results of anti-IFN-I antibody tests performed by three methods, with 100% specificity and sensitivity for microarray-based assay. Although only the cell-based assay can determine the neutralizing activity of autoantibodies, the microarray-based assay can serve as a highly specific and sensitive screening test to identify anti-IFN-I antibody positive patients.
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Affiliation(s)
- Nurana Nuralieva
- Endocrinology Research Centre, Ministry of Health of Russia, 117036 Moscow, Russia
| | - Marina Yukina
- Endocrinology Research Centre, Ministry of Health of Russia, 117036 Moscow, Russia
| | - Leila Sozaeva
- Endocrinology Research Centre, Ministry of Health of Russia, 117036 Moscow, Russia
| | - Maxim Donnikov
- Medical Institute, Surgut State University, 628416 Surgut, Russia
| | | | - Ekaterina Troshina
- Endocrinology Research Centre, Ministry of Health of Russia, 117036 Moscow, Russia
| | - Elizaveta Orlova
- Endocrinology Research Centre, Ministry of Health of Russia, 117036 Moscow, Russia
| | - Dmitry Gryadunov
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia
| | - Elena Savvateeva
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia
- Correspondence:
| | - Ivan Dedov
- Endocrinology Research Centre, Ministry of Health of Russia, 117036 Moscow, Russia
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Troshina E, Yukina M, Nuralieva N, Vasilyev E, Rebrova O, Akhmatova R, Ikonnikova A, Savvateeva E, Gryadunov D, Melnichenko G, Mokrysheva N. Association of Alleles of Human Leukocyte Antigen Class II Genes and Severity of COVID-19 in Patients of the 'Red Zone' of the Endocrinology Research Center, Moscow, Russia. Diseases 2022; 10:diseases10040099. [PMID: 36412593 PMCID: PMC9680278 DOI: 10.3390/diseases10040099] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 10/30/2022] [Accepted: 10/31/2022] [Indexed: 11/06/2022] Open
Abstract
The aim of this study was to assess the correlations of clinical features of patients with moderate and severe courses of COVID-19, comorbidity (endocrine, autoimmune, cardiovascular, oncological, and pulmonary diseases), and alleles of the HLA class II system genes. One hundred COVID-19 patients hospitalized in the Endocrinology Research Centre, Moscow, Russia, were analyzed for age, gender, smoking, comorbidity, and invasive mechanical ventilation. Computer tomography was used to assess the severity of the disease. HLA-DRB1, HLA-DQA1, and HLA-DQB1 alleles were identified in samples from 100 patients and samples from 327 randomly selected individuals collected in the prepandemic period (control group). There was no association of gender, age, weight, body mass index, smoking, and comorbidity with the severity of COVID-19. Allele DQB1*06:02-8 was more common in patients (p < 0.00005), and DQB1*06:01 and DQB1*05:03 were more common in the control group (p < 0.00005, and p = 0.0011, respectively). DQB1*06:02-8 can probably be considered as predisposing to moderate and severe COVID-19, and DQB1*06:01 can be considered as protective. No association of these alleles with comorbidity was found. Our results suggest that carriers of predisposing alleles, with cardiovascular and non-autoimmune endocrine diseases, should take more stringent preventive measures, and if infected, a more aggressive COVID-19 treatment strategy should be used.
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Affiliation(s)
- Ekaterina Troshina
- Endocrinology Research Centre, Ministry of Health of the Russian Federation, 117036 Moscow, Russia
| | - Marina Yukina
- Endocrinology Research Centre, Ministry of Health of the Russian Federation, 117036 Moscow, Russia
- Correspondence:
| | - Nurana Nuralieva
- Endocrinology Research Centre, Ministry of Health of the Russian Federation, 117036 Moscow, Russia
| | - Evgeny Vasilyev
- Endocrinology Research Centre, Ministry of Health of the Russian Federation, 117036 Moscow, Russia
| | - Olga Rebrova
- Endocrinology Research Centre, Ministry of Health of the Russian Federation, 117036 Moscow, Russia
| | - Ravida Akhmatova
- Endocrinology Research Centre, Ministry of Health of the Russian Federation, 117036 Moscow, Russia
| | - Anna Ikonnikova
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia
| | - Elena Savvateeva
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia
| | - Dmitry Gryadunov
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, 119991 Moscow, Russia
| | - Galina Melnichenko
- Endocrinology Research Centre, Ministry of Health of the Russian Federation, 117036 Moscow, Russia
| | - Natalia Mokrysheva
- Endocrinology Research Centre, Ministry of Health of the Russian Federation, 117036 Moscow, Russia
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Yukina M, Nuralieva N, Troshina E, Malysheva N, Zuraeva Z, Bratchikova A. Clinical Case of Surreptitious Hypoglycemia Due to Deliberate Insulin Analog Administration. Clin Med Insights Case Rep 2021; 14:11795476211009234. [PMID: 33958903 PMCID: PMC8064658 DOI: 10.1177/11795476211009234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/16/2021] [Indexed: 11/24/2022]
Abstract
Hypoglycemic syndrome is a life-threatening condition that can lead to hypoglycemic coma and death. Surreptitious hypoglycemic syndrome is the deliberate use of insulin preparations or oral hypoglycemic drugs aimed to reduce blood glucose level. If human insulin is injected, high level of immunoreactive insulin (IRI) and low level of C-peptide at the moment of hypoglycemia are always detected. However, the fact of deliberate administration of insulin analogs is difficult to prove. In these cases if insulin kit test with low cross-reactivity with insulin analogs is used, the low levels of IRI and C-peptide will be suspected. Some experts suggest the presence of cross reactivity with analogs of insulin in a number of commercial kits, which makes it possible to detect cases of surreptitious hypoglycemia. We present a clinical case of a patient with surreptitious hypoglycemia due to the administration of insulin analogs and discuss the problems of its laboratory diagnosis.
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Yukina M, Erofeeva T, Nuralieva N, Andreeva T, Savvateeva E, Dudko N, Troshina E, Rogaev E, Melnichenko G. Novel Gene Mutations Regulating Immune Responses in Autoimmune Polyglandular Syndrome With an Atypical Course. J Endocr Soc 2021; 5:bvab077. [PMID: 34235359 PMCID: PMC8252644 DOI: 10.1210/jendso/bvab077] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Indexed: 11/19/2022] Open
Abstract
Context Autoimmune polyglandular syndrome (APS) is a cluster of endocrine disorders arising from immune dysregulation, often combined with damage to nonendocrine organs. There are 2 types of APS: type 1 and type 2 (APS-1 and APS-2, respectively). In clinical practice, an atypical course of APS is often observed. Objective This work aims to find a novel genetic predictor of APS. Methods We performed exome sequencing in 2 patients with an atypical clinical APS picture and members of their families. Patient A presented with a manifestation of APS-2 in early childhood and patient B with a late manifestation of the main components of APS-1. Results In patient B, we identified inherited compound mutations as a novel combination of the c.769C > T and c.821delG alleles of AIRE and genetic variation in the CIITA gene. No homozygous or compound mutations in AIRE were found in patient A, but we did reveal mutations in genes encoding regulatory proteins of innate and acquired immunity in this patient. Conclusion Our data revealed novel combination of mutations in the AIRE gene in atypical APS and imply that mutations in immune-related genes may modify the clinical manifestation of APS in AIRE-mutation carriers and contribute to the development of autoimmune pathology in non-AIRE carriers with atypical APS.
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Affiliation(s)
- Marina Yukina
- Endocrinology Research Centre, Moscow 117036, Russia
| | - Taisia Erofeeva
- Laboratory of Evolutionary genomics, Department of Genomics and Human Genetics, Vavilov Institute of General Genetics, Russian Academy of Sciences, Moscow 119333, Russia
| | | | - Tatiana Andreeva
- Laboratory of Evolutionary genomics, Department of Genomics and Human Genetics, Vavilov Institute of General Genetics, Russian Academy of Sciences, Moscow 119333, Russia.,Center for Genetics and Genetic Technologies, Faculty of Biology, Lomonosov Moscow State University, Moscow 119192, Russia
| | - Elena Savvateeva
- Center for Precision Genome Editing and Genetic Technologies for Biomedicine, Engelhardt Institute of Molecular Biology, Russian Academy of Sciences, Moscow 119991, Russia
| | - Natalia Dudko
- Laboratory of Evolutionary genomics, Department of Genomics and Human Genetics, Vavilov Institute of General Genetics, Russian Academy of Sciences, Moscow 119333, Russia
| | | | - Evgeny Rogaev
- Laboratory of Evolutionary genomics, Department of Genomics and Human Genetics, Vavilov Institute of General Genetics, Russian Academy of Sciences, Moscow 119333, Russia.,Center for Genetics and Genetic Technologies, Faculty of Biology, Lomonosov Moscow State University, Moscow 119192, Russia.,Center for Genetics and Life Science, Sirius University of Science and Technology, Sochi 354340, Russia.,Department of Psychiatry, University of Massachusetts Medical School, Worcester, Massachusetts 01604, USA
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Yukina M, Nuralieva N, Sorkina E, Troshina E, Tiulpakov A, Belaya Z, Melnichenko G. Atypical progeroid syndrome (p.E262K LMNA mutation): a rare cause of short stature and osteoporosis. Endocrinol Diabetes Metab Case Rep 2021; 2021:EDM200188. [PMID: 33859056 PMCID: PMC8052577 DOI: 10.1530/edm-20-0188] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 03/15/2021] [Indexed: 11/08/2022] Open
Abstract
SUMMARY Lamin A/C (LMNA) gene mutations cause a heterogeneous group of progeroid disorders, including Hutchinson-Gilford progeria syndrome, mandibuloacral dysplasia, atypical progeroid syndrome (APS) and generalized lipodystrophy-associated progeroid syndrome (GLPS). All of those syndromes are associated with some progeroid features, lipodystrophy and metabolic complications but vary differently depending on a particular mutation and even patients carrying the same gene variant are known to have clinical heterogeneity. We report a new 30-year-old female patient from Russia with an APS and generalized lipodystrophy (GL) due to the heterozygous de novo LMNA p.E262K mutation and compare her clinical and metabolic features to those of other described patients with APS. Despite many health issues, short stature, skeletal problems, GL and late diagnosis of APS, our patient seems to be relatively metabolically healthy for her age when compared to previously described patients with APS. LEARNING POINTS Atypical progeroid syndromes (APS) are rare and heterogenic with different age of onset and degree of metabolic disorders, which makes this diagnosis very challenging for clinicians and may be missed until the adulthood. The clinical picture of the APS depends on a particular mutation in the LMNA gene, but may vary even between the patients with the same mutation. The APS due to a heterozygous LMNA p.E262K mutation, which we report in this patient, seems to have association with the generalized lipodystrophy, short stature and osteoporosis, but otherwise, it seems to cause relatively mild metabolic complications by the age of 30. The patients with APS and lipodystrophy syndromes require a personalized and multidisciplinary approach, and so they should be referred to highly specialized reference-centres for diagnostics and treatment as early as possible. Because of the high heterogeneity of such a rare disease as APS, every patient's description is noteworthy for a better understanding of this challenging syndrome, including the analysis of genotype-phenotype correlations.
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Kriger A, Berelavichus S, Gorin D, Galkin G, Yukina M, Ilovayskaya I, Zektser V, Nuralieva N, Kaldarov AR. Successful surgical treatment of a patient with primary insulinoma of the liver. J Surg Case Rep 2020; 2020:rjaa519. [PMID: 33391648 PMCID: PMC7769218 DOI: 10.1093/jscr/rjaa519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 11/09/2020] [Accepted: 11/18/2020] [Indexed: 11/13/2022] Open
Abstract
Insulinoma is the most frequent functional neuroendocrine tumor of the pancreas, which causes organic hyperinsulinism with severe hypoglycemia. There are no cases of primary insulinoma of the liver described. A 63-year-old female was admitted to our center presenting symptoms of severe hypoglycemia due to confirmed endogenic hyperinsulinism. None of the performed diagnostic procedures could reveal a pancreatic tumor. However, a pathologic mass in the sixth segment of the liver was detected. We performed arterial calcium stimulation that showed increased levels of insulin and c-peptide in almost all stimulated arteries. The highest and most prolonged peaks were detected at the points of the common hepatic artery and the right hepatic artery. After the surgical removal of the liver tumor, the blood glucose level was stabilized within the normal range. Post-operative pathomorphological investigation confirmed the diagnosis of a neuroendocrine tumor. The long-term survival results show correct treatment tactics without any signs of disease recurrence.
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Affiliation(s)
- A Kriger
- Department No.1 of A.V. Vishnevsky Center of Surgery, 5 Universitetsky Prospekt 289, Moscow 119296, Russia
| | - S Berelavichus
- Department No.1 of A.V. Vishnevsky Center of Surgery, 16/1 Solov'iny Proezd 139, Moscow 117593, Russia
| | - D Gorin
- Department No.1 of A.V. Vishnevsky Center of Surgery, 40 Seslavinskaya Street 48, Moscow 121309, Russia
| | - G Galkin
- Department No.1 of A.V. Vishnevsky Center of Surgery, 37/21 Tuhachevskogo Street 131, Moscow 123159, Russia
| | - M Yukina
- Department of National Medical Research Centre of Endocrinology, 11, Dm Ulyanova, Moscow 117036, Russia
| | - I Ilovayskaya
- Moscow Regional Research & Clinical Institute (MONIKI), 61/2 Schepkina Street, Moscow 129110, Russia
| | - V Zektser
- I.M. Sechenov First Medical State University, 8/2 Trubetskaya street, Moscow 119991, Russia
| | - N Nuralieva
- Department of National Medical Research Centre of Endocrinology 11, Dm Ulyanova, Moscow 117036, Russia
| | - A R Kaldarov
- Department No.1 of A.V. Vishnevsky Center of Surgery, 9, Novoe Shosse 78, Drojjino, Moscow 142718, Russia
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Yukina M, Nuralieva N, Solovyev M, Troshina E, Vasilyev E. Insulin autoimmune syndrome. Endocrinol Diabetes Metab Case Rep 2020; 2020:EDM190159. [PMID: 32554828 PMCID: PMC7354712 DOI: 10.1530/edm-19-0159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 04/28/2020] [Indexed: 11/29/2022] Open
Abstract
SUMMARY Insulin autoimmune syndrome (Hirata's disease) is a disorder caused by development of autoantibodies to insulin and manifested by hypoglycaemic syndrome. The overwhelming majority of physicians do not include it in the differential diagnosis of hypoglycaemic states because of a misconception of an extremely low prevalence of this condition. This results in unnecessary drug therapy and unjustified surgical interventions in patients that otherwise would be successfully treated conservatively. This disease is strongly associated with certain alleles of the HLA gene. In most cases, this condition develops in predisposed individuals taking drugs containing sulfhydryl groups. Formation of autoantibodies to insulin may be observed in patients with other autoimmune disorders, as well as in those with multiple myeloma or monoclonal gammopathy of undetermined significance. This paper presents the first Russian case report of insulin autoimmune syndrome in an adult patient. LEARNING POINTS Insulin autoimmune syndrome, Hirata's disease, anti-insulin antibodies, and hypoglycaemia.
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Affiliation(s)
- Marina Yukina
- Department of Therapeutic Endocrinology, Endocrinology Research Centre (ERC), Moscow, Russia
| | - Nurana Nuralieva
- Department of Therapeutic Endocrinology, Endocrinology Research Centre (ERC), Moscow, Russia
| | - Maksim Solovyev
- Department of Therapeutic Endocrinology, Endocrinology Research Centre (ERC), Moscow, Russia
| | - Ekaterina Troshina
- Department of Therapeutic Endocrinology, Endocrinology Research Centre (ERC), Moscow, Russia
- Russian Academy of Sciences, Endocrinology Service, Department of Therapeutic Endocrinology, Endocrinology Research Centre (ERC), Moscow, Russia
| | - Evgeny Vasilyev
- Laboratory of Inherited Endocrine Disorders, Endocrinology Research Centre (ERC), Moscow, Russia
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