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Bezirganoglu H, Okur N, Celik K, Tas FF, Ozbek MN. Evaluation and management of neonatal onset hyperinsulinemic hypoglycemia: a single neonatal center experience. J Matern Fetal Neonatal Med 2023; 36:2272014. [PMID: 37860935 DOI: 10.1080/14767058.2023.2272014] [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: 06/14/2023] [Accepted: 10/12/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVES To evaluate the clinical characteristics and treatment options of neonates requiring prolonged hospitalization due to persistent hyperinsulinemic hypoglycemia (HH). METHODS This retrospective cohort study included infants >34 weeks of gestation at birth who were born in our hospital between 2018 and 2021, diagnosed with HH, and required diazoxide within the first 28 days of life. The baseline clinical characteristics, age at the time of diagnosis and treatment options in diazoxide resistance cases were recorded. Genetic mutation analysis, if performed, was also included. RESULTS A total of 32 infants diagnosed with neonatal HH were followed up. Among the cohort, 25 infants were classified as having transient form of HH and seven infants were classified as having congenital hyperinsulinemic hypoglycemia (CHI). Thirty-one percent of the infants had no risk factors. The median birth weight was significantly higher in the CHI group, whereas no differences were found in other baseline characteristics. Patients diagnosed with CHI required higher glucose infusion rate, higher doses, and longer duration of diazoxide treatment than those in the transient HH group. Eight patients were resistant to diazoxide, and six of them required treatment with octreotide and finally sirolimus. Sirolimus prevented the need of pancreatectomy in five of six patients without causing major side effects. Homozygous mutations in the ABCC8 gene were found in four patients with CHI. CONCLUSIONS The risk of persistent neonatal hyperinsulinism should be considered in hypoglycemic neonates particularly located in regions with high rates of consanguinity. Our study demonstrated sirolimus as an effective treatment option in avoiding pancreatectomy in severe cases.
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Affiliation(s)
- Handan Bezirganoglu
- Division of Neonatology, Trabzon Kanuni Training and Research Hospital, Trabzon, Turkey
| | - Nilufer Okur
- Division of Neonatology, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
| | - Kiymet Celik
- Division of Neonatology, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
| | - Funda Feryal Tas
- Division of Pediatric Endocrinology, Diyarbakir Gazi Yasargil Training and Research Hospital, Diyarbakır, Turkey
| | - Mehmet Nuri Ozbek
- Department of Pediatrics, Division of Pediatric Endocrinology, Mardin Artuklu University Medical School, Mardin, Turkey
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Al Shidhani A, Al Hinai A, Al Thihli K, Al Mandhari H, Al Yaarubi S, Ullah I, Al-Hashmi N, Al Murshedi F. Congenital Hyperinsulinism and Maple Syrup Urine Disease: A Challenging Combination. J Clin Res Pediatr Endocrinol 2023; 15:302-306. [PMID: 34738771 PMCID: PMC10448551 DOI: 10.4274/jcrpe.galenos.2021.2021.0173] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Accepted: 09/28/2021] [Indexed: 12/01/2022] Open
Abstract
Congenital hyperinsulinism (CHI) is the most common cause of persistent hypoglycemia in infancy. CHI is a challenging disease to diagnose and manage. Moreover, complicating the course of the disease with another metabolic disease, in this case maple syrup urine disease (MSUD), adds more challenges to the already complex management. We report a term neonate who developed symptomatic, non-ketotic hypoglycemia with a blood glucose (BG) level of 1.9 mmol/L at 21-hours of life. A critical sample at that time showed high serum insulin and C-peptide levels confirming the diagnosis of CHI. Tandem mass spectrometry done at the same time was suggestive of MSUD which was confirmed by high performance liquid chromatography. The diagnosis of both conditions was subsequently confirmed by molecular genetic testing. His hypoglycemia was managed with high glucose infusion with medical therapy for CHI and branched chain amino acids (BCAA) restricted medical formula. At the age of four months, a near-total pancreatectomy was done, due to the failure of conventional therapy. Throughout his complicated course, he required meticulous monitoring of his BG and modified plasma amino acid profile aiming to maintain the BG at ≥3.9 mmol/L and levels of the three BCAAs at the disease therapeutic targets for his age. The patient is currently 29 months old and has normal growth and development. This patient is perhaps the only known case of the co-occurrence of CHI with MSUD. Both hypoglycemia and leucine encephalopathy can result in death or permanent neurological damage. The management of CHI and MSUD in combination is very challenging.
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Affiliation(s)
- Azza Al Shidhani
- Sultan Qaboos University Hospital, Department of Child Health, Muscat, Oman
| | | | - Khalid Al Thihli
- Sultan Qaboos University Hospital, Department of Genetics, Muscat, Oman
| | - Hilal Al Mandhari
- Sultan Qaboos University Hospital, Department of Child Health, Muscat, Oman
| | - Saif Al Yaarubi
- Sultan Qaboos University Hospital, Department of Child Health, Muscat, Oman
| | - Irfan Ullah
- Sultan Qaboos University Hospital, Department of Child Health, Muscat, Oman
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Grier AE, McGill JB, Lord SM, Speake C, Greenbaum C, Chamberlain CE, German MS, Anderson MS, Hirsch IB. ABCC8-Related Monogenic Diabetes Presenting Like Type 1 Diabetes in an Adolescent. AACE Clin Case Rep 2023; 9:101-103. [PMID: 37520758 PMCID: PMC10382606 DOI: 10.1016/j.aace.2023.04.001] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/11/2023] [Accepted: 04/03/2023] [Indexed: 08/01/2023] Open
Abstract
Background Identifying cases of diabetes caused by single gene mutations between the more common type 1 diabetes (T1D) and type 2 diabetes (T2D) is a difficult but important task. We report the diagnosis of ATP-binding cassette transporter sub-family C member 8 (ABCC8)-related monogenic diabetes in a 35-year-old woman with a protective human leukocyte antigen (HLA) allele who was originally diagnosed with T1D at 18 years of age. Case Report Patient A presented with polyuria, polydipsia, and hypertension at the age of 18 years and was found to have a blood glucose > 500 mg/dL (70-199 mg/dL) and an HbA1C (hemoglobin A1C) >14% (4%-5.6%). She had an unmeasurable C-peptide but no urine ketones. She was diagnosed with T1D and started on insulin therapy. Antibody testing was negative. She required low doses of insulin and later had persistence of low but detectable C-peptide. At the age of 35 years, she was found to have a protective HLA allele, and genetic testing revealed a pathogenic mutation in the ABCC8 gene. The patient was then successfully transitioned to sulfonylurea therapy. Discussion Monogenic diabetes diagnosed in adolescence typically presents with mild to moderate hyperglycemia, positive family history and, in some cases, other organ findings or dysfunction. The patient in this report presented with very high blood glucose, prompting the diagnosis of T1D. When she was found to have a protective HLA allele, further investigation revealed the mutation in the sulfonylurea receptor gene, ABCC8. Conclusion Patients suspected of having T1D but with atypical clinical characteristics such as negative autoantibodies, low insulin requirements, and persistence of C-peptide should undergo genetic testing for monogenic diabetes.
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Affiliation(s)
- Alexandra E. Grier
- Department of Pediatrics, St. Louis Children’s Hospital, St. Louis, Missouri
| | - Janet B. McGill
- Division of Endocrinology, Metabolism and Lipid Research, Washington University School of Medicine, St. Louis, Missouri
| | - Sandra M. Lord
- Diabetes Clinical Research Program and Center for Interventional Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington
| | - Cate Speake
- Diabetes Clinical Research Program and Center for Interventional Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington
| | - Carla Greenbaum
- Diabetes Clinical Research Program and Center for Interventional Immunology, Benaroya Research Institute at Virginia Mason, Seattle, Washington
| | - Chester E. Chamberlain
- Department of Medicine, Diabetes Center, University of California, San Francisco, California
- Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California, San Francisco, California
| | - Michael S. German
- Department of Medicine, Diabetes Center, University of California, San Francisco, California
- Eli and Edythe Broad Center of Regeneration Medicine and Stem Cell Research, University of California, San Francisco, California
| | - Mark S. Anderson
- Department of Medicine, Diabetes Center, University of California, San Francisco, California
| | - Irl B. Hirsch
- Division of Metabolism, Endocrinology, and Nutrition, Department of Medicine, University of Washington School of Medicine, Seattle, Washington
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Işık E, Demirbilek H, Houghton JA, Ellard S, Flanagan SE, Hussain K. Congenital Hyperinsulinism and Evolution to Sulfonylurearesponsive Diabetes Later in Life due to a Novel Homozygous p.L171F ABCC8 Mutation. J Clin Res Pediatr Endocrinol 2019; 11:82-87. [PMID: 29739729 PMCID: PMC6398184 DOI: 10.4274/jcrpe.galenos.2018.2018.0077] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Congenital hyperinsulinism (CHI) is the most common cause of persistent hypoglycemia in infants and children. Recessive inactivating mutations in the ABCC8 and KCNJ11 genes account for approximately 50% of all CHI cases. Hyperinsulinaemic hypoglycaemia in infancy and diabetes in later life have been reported in patients with HNF1A, HNF4A and ABCC8 mutations. Herein, we present a child who was diagnosed with CHI at birth, then developed diabetes mellitus at the age of nine years due to a novel homozygous missense, p.L171F (c.511C>T) mutation in exon 4 of ABCC8. The parents and one sibling were heterozygous carriers, whilst a younger sibling who had transient neonatal hypoglycemia was homozygous for the mutation. The mother and (maternal) uncle, who was also heterozygous for the mutation, developed diabetes within their third decade of life. The preliminary results of sulphonylurea (SU) treatment was suggestive of SU responsiveness. Patients with homozygous ABCC8 mutations can present with CHI in the newborn period, the hyperinsulinism can show variability in terms of clinical severity and age at presentation and can cause diabetes later in life. Patients with homozygous ABCC8 mutations who are managed medically should be followed long-term as they may be at increased risk of developing diabetes after many years.
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Affiliation(s)
- Emregül Işık
- Gaziantep Children’s Hospital, Clinics of Paediatric Endocrinology, Gaziantep, Turkey
| | - Hüseyin Demirbilek
- Hacettepe University Faculty of Medicine, Department of Paediatric Endocrinology, Ankara, Turkey,* Address for Correspondence: Hacettepe University Faculty of Medicine, Department of Paediatric Endocrinology, Ankara, Turkey Phone: +90 312 305 11 24 E-mail:
| | - Jayne A. Houghton
- University of Exeter Medical School, Institute of Biomedical and Clinical Science, Exeter, United Kingdom
| | - Sian Ellard
- University of Exeter Medical School, Institute of Biomedical and Clinical Science, Exeter, United Kingdom
| | - Sarah E. Flanagan
- University of Exeter Medical School, Institute of Biomedical and Clinical Science, Exeter, United Kingdom
| | - Khalid Hussain
- Sidra Medical and Research Center, Clinic of Paediatric Medicine, Doha, Qatar
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Katanic D, Vorgučin I, Hattersley A, Ellard S, Houghton JAL, Obreht D, Knežević Pogančev M, Vlaški J, Pavkov D. A successful transition to sulfonylurea treatment in male infant with neonatal diabetes caused by the novel abcc8 gene mutation and three years follow-up. Diabetes Res Clin Pract 2017; 129:59-61. [PMID: 28511139 PMCID: PMC5612402 DOI: 10.1016/j.diabres.2017.04.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 04/04/2017] [Accepted: 04/26/2017] [Indexed: 12/23/2022]
Abstract
Neonatal diabetes mellitus is a rare monogenic disease with incidence of 1/90,000 newborns. A case of two months aged male infant with life threatening diabetic ketoacidosis is presented with novel ABCC8 gene mutation (p.F577L), successful transition from insulin to sulfonylurea and follow-up of three years.
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MESH Headings
- Child, Preschool
- Diabetes Mellitus, Type 1/diagnosis
- Diabetes Mellitus, Type 1/drug therapy
- Diabetes Mellitus, Type 1/genetics
- Diabetic Ketoacidosis/diagnosis
- Diabetic Ketoacidosis/drug therapy
- Diabetic Ketoacidosis/genetics
- Drug Substitution
- Follow-Up Studies
- Humans
- Hypoglycemic Agents/administration & dosage
- Infant
- Infant, Newborn
- Infant, Newborn, Diseases/diagnosis
- Infant, Newborn, Diseases/drug therapy
- Infant, Newborn, Diseases/genetics
- Insulin/administration & dosage
- Male
- Mutation
- Mutation, Missense
- Potassium Channels, Inwardly Rectifying/genetics
- Sulfonylurea Compounds/administration & dosage
- Sulfonylurea Receptors/genetics
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Affiliation(s)
- Dragan Katanic
- University of Novi Sad, Faculty of Medicine, Institute for Health Care of Children and Youth of Vojvodina, Serbia.
| | - Ivana Vorgučin
- University of Novi Sad, Faculty of Medicine, Institute for Health Care of Children and Youth of Vojvodina, Serbia
| | | | | | | | - Dragana Obreht
- University of Novi Sad, Department of Biology-Genetics, Serbia
| | - Marija Knežević Pogančev
- University of Novi Sad, Faculty of Medicine, Institute for Health Care of Children and Youth of Vojvodina, Serbia
| | - Jovan Vlaški
- University of Novi Sad, Faculty of Medicine, Institute for Health Care of Children and Youth of Vojvodina, Serbia
| | - Danijela Pavkov
- University of Novi Sad, Faculty of Medicine, Institute for Health Care of Children and Youth of Vojvodina, Serbia
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