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Cromer SJ, Sella AC, Rosenberg E, Scully K, McDonnell M, Abreu AP, Weil M, Bernstein SN, Quinn M, Powe C, Mitchell DM, Udler MS. Report of Prolonged Neonatal Hypoglycemia in Three Infants of Mothers With Variants in HNF1A. AACE Clin Case Rep 2022; 8:224-230. [PMID: 36189138 PMCID: PMC9508595 DOI: 10.1016/j.aace.2022.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 07/18/2022] [Accepted: 07/22/2022] [Indexed: 11/24/2022] Open
Abstract
Background/Objective Genetic variants in hepatic nuclear factor 1α (HNF1A) cause maturity-onset diabetes of the young (MODY). We sought to examine whether HNF1A MODY variants also cause neonatal hypoglycemia. Case Report We present 3 infants with variants in HNF1A shared with their mothers. The infants experienced neonatal hypoglycemia, 2 extending beyond 1 year and the third resolving by 28 days, and all were large for gestational age (birth weights of >99th percentile). In 2 cases, genetic testing for neonatal hypoglycemia revealed pathogenic variants in HNF1A; 1 mother was previously diagnosed with HNF1A MODY, and the other's genetic testing and ultimate MODY diagnosis were prompted by her child's hypoglycemia workup. In the third case, the infant's persistent hypoglycemia prompted genetic testing, revealing an HNF1A variant of uncertain significance, which was then identified in the mother. Discussion Genetic variants causing HNF1A MODY have not been definitively linked to neonatal hypoglycemia or fetal overgrowth in utero. MODY caused by HNF1A is clinically similar to that caused by HNF4A, for which a causal relationship with neonatal hypoglycemia is more certain. Case reports have previously implicated variants in HNF1A in congenital hyperinsulinism; however, these cases have generally not been in families with MODY. The cases presented here suggest that HNF1A variants causing MODY may also cause neonatal hypoglycemia. Conclusion Although confounding factors make the assessment of neonatal hypoglycemia challenging, these cases offer potential support for single genetic variants in HNF1A causing both MODY and neonatal hypoglycemia, with associated fetal overgrowth in utero.
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Key Words
- CGM, continuous glucose monitoring
- CHI, congenital hyperinsulinism
- EFW, estimated fetal weight
- HNF1A
- HNF1A, hepatic nuclear factor-1α
- HNF4A, hepatocyte nuclear factor-4α
- HbA1C, hemoglobin A1C
- MODY
- MODY, maturity-onset diabetes of the young
- NICU, neonatal intensive care unit
- T1D, type 1 diabetes
- T2D, type 2 diabetes
- VUS, variant of uncertain significance
- congenital hyperinsulinism
- diabetes
- genetic variants
- macrosomia
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Affiliation(s)
- Sara Jane Cromer
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- The Broad Institute, Boston, Massachusetts
| | - Aluma Chovel Sella
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Emily Rosenberg
- Harvard Medical School, Boston, Massachusetts
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Kevin Scully
- Harvard Medical School, Boston, Massachusetts
- Division of Pediatric Endocrinology, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
| | - Marie McDonnell
- Harvard Medical School, Boston, Massachusetts
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Ana Paula Abreu
- Harvard Medical School, Boston, Massachusetts
- Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts
- Brigham Center for Endocrine Genetics, Boston, Massachusetts
| | - Michelle Weil
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
| | - Sarah N. Bernstein
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts
| | - Maryanne Quinn
- Harvard Medical School, Boston, Massachusetts
- Division of Pediatric Endocrinology, Department of Pediatrics, Boston Children’s Hospital, Boston, Massachusetts
| | - Camille Powe
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- The Broad Institute, Boston, Massachusetts
| | - Deborah M. Mitchell
- Division of Pediatric Endocrinology, Department of Pediatrics, Massachusetts General Hospital, Boston, Massachusetts
| | - Miriam S. Udler
- Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts
- Harvard Medical School, Boston, Massachusetts
- The Broad Institute, Boston, Massachusetts
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