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Perspective on the Genetics and Diagnosis of Congenital Hyperinsulinism Disorders
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CONTEXT: Congenital hyperinsulinism (HI) is the most common cause of hypoglycemia in children. The risk of permanent brain injury in infants with HI continues to be as high as 25-50% due to delays in diagnosis and inadequate treatment. Congenital HI has been described since the birth of the JCEM under various terms, including "idiopathic hypoglycemia of infancy," "leucine-sensitive hypoglycemia," or "nesidioblastosis." EVIDENCE ACQUISITION: In the past 20 years, it has become apparent that HI is caused by genetic defects in the pathways that regulate pancreatic β-cell insulin secretion. EVIDENCE SYNTHESIS: There are now 11 genes associated with monogenic forms of HI (ABCC8, KCNJ11, GLUD1, GCK, HADH1, UCP2, MCT1, HNF4A, HNF1A, HK1, PGM1), as well as several syndromic genetic forms of HI (eg, Beckwith-Wiedemann, Kabuki, and Turner syndromes). HI is also the cause of hypoglycemia in transitional neonatal hypoglycemia and in persistent hypoglycemia in various groups of high-risk neonates (such as birth asphyxia, small for gestational age birthweight, infant of diabetic mother). Management of HI is one of the most difficult problems faced by pediatric endocrinologists and frequently requires difficult choices, such as near-total pancreatectomy and/or highly intensive care with continuous tube feedings. For 50 years, diazoxide, a KATP channel agonist, has been the primary drug for infants with HI; however, it is ineffective in most cases with mutations of ABCC8 or KCNJ11, which constitute the majority of infants with monogenic HI. CONCLUSIONS: Genetic mutation testing has become standard of care for infants with HI and has proven to be useful not only in projecting prognosis and family counseling, but also in diagnosing infants with surgically curable focal HI lesions. (18)F-fluoro-L-dihydroxyphenylalanine ((18)F-DOPA) PET scans have been found to be highly accurate for localizing such focal lesions preoperatively. New drugs under investigation provide hope for improving the outcomes of children with HI.
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“While the pathophysiology of persistent hyperinsulinemic hypoglycemia in childhood and infancy, which is morphologically similar to NIPHS, is well understood from a genetic and functional point of view, mechanistic data on adult-onset NIPHS is scarce [49].”
From An Uncommon Cause of Recurrent Presyncope, Dizziness, and Tachycardia: A Case Report of Diffuse, Adult-Onset Nesidioblastosis/Non-Insulinoma Pancreatogenous Hypoglycemia Syndrome (NIPHS) (2023) · cites this paper as [49]
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“Loss-of-function mutations cause congenital hyperinsulinism because they result in permanent membrane depolarization and persistent insulin release (479, 644, 681).”
From Pancreatic β-Cell Electrical Activity and Insulin Secretion: Of Mice and Men (2018) · cites this paper as [644]
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Avrahami, D., Li, C., Yu, M., Jiao, Y., Zhang, J., Naji, A., Ziaie, S., Gläser, B., & Kaestner, K. H. (2014) · Journal of Clinical Investigation · doi:10.1172/jci69519 · Cited by 66
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León, D. D. D., Li, C., Delson, M. I., Matschinsky, F. M., Stanley, C. A., & Stoffers, D. A. (2008) · Journal of Biological Chemistry · doi:10.1074/jbc.m804372200 · Cited by 64
Self-citationHyperinsulinism in Developmental Syndromes
Kapoor, R. R., James, C. T., & Hussain, K. (2009) · Endocrine development · doi:10.1159/000207480 · Cited by 61
Hypertrophic cardiomyopathy in neonates with congenital hyperinsulinism
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Self-citationExercise induced hypoglycaemic hyperinsulinism
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Arya, V. B., Flanagan, S. E., Schober, E., Rami-Merhar, B. M., Ellard, S., & Hussain, K. (2013) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2013-3228 · Cited by 37
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Self-citationTransitional neonatal hypoglycemia
Jobe, A. H. (2015) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2015.04.024 · Cited by 34
High Prevalence of Severe Circulatory Complications with Diazoxide in Premature Infants
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Alkhayyat, H., Christesen, H. T., Steer, J., Stewart, H. S., Brusgaard, K., & Hussain, K. (2006) · Journal of Pediatric Endocrinology and Metabolism · doi:10.1515/jpem.2006.19.12.1451 · Cited by 29
Nesidioblastosis No Longer! It's All about Genetics
Palladino, A., & Stanley, C. A. (2011) · The Journal of Clinical Endocrinology & Metabolism · doi:10.1210/jc.2011-0164 · Cited by 29
Self-citationMonogenic Hyperinsulinemic Hypoglycemia Disorders
(2012) · Frontiers in diabetes · doi:10.1159/isbn.978-3-8055-9944-3 · Cited by 27
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Self-citationA novel atypical presentation of insulin autoimmune syndrome (Hirata’s disease) in a child
Alves, C., Fernandes, J. C., León, D. D. D., Snider, K. E., & Stanley, C. A. (2013) · Journal of Pediatric Endocrinology and Metabolism · doi:10.1515/jpem-2013-0215 · Cited by 23
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Self-citationHyperinsulinism Due to Activating Mutations of Glucokinase
Sayed, S. U., Matschinsky, F. M., & Stanley, C. A. (2012) · Frontiers in diabetes · doi:10.1159/000334521 · Cited by 10
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Exercise-Induced Hyperinsulinism: A Failure of Monocarboxylate Transporter 1 Expression Silencing
Otonkoski, T., & Meißner, T. (2012) · Frontiers in diabetes · doi:10.1159/000334529 · Cited by 4
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Metadata
- Authors
- Stanley, C. A.
- Affiliations
- Children's Hospital of Philadelphia (US)
- Corresponding author
- Stanley, Charles A.
- ORCID
- Stanley, Charles A.
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2016-03
- Volume
- 101
- Issue
- 3
- Pages
- 815-826
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- PMC
- PMC4803157
- OpenAlex
- W2277559429
- Cited by
- 239
- References
- 104
- Citations by year
- 2026: 14 · 2025: 13 · 2024: 13 · 2023: 13 · 2022: 24 · 2021: 25 · 2020: 36 · 2019: 24 · 2018: 39 · 2017: 25 · 2016: 13
- FWCI
- 6.67
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Children's Hospital of Philadelphia
- National Institutes of Health
- National Institute of Diabetes and Digestive and Kidney Diseases (R37DK056268)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pancreatic function and diabetes
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Genetics › Diabetes and associated disorders
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Clinical Biochemistry › Metabolism and Genetic Disorders
- Keywords
- congenital hyperinsulinism, pancreatic beta-cell insulin secretion, ABCC8, KCNJ11, genetic diagnosis, diazoxide, near-total pancreatectomy, 18F-DOPA PET, focal pancreatic lesions, Beckwith-Wiedemann syndrome, Kabuki syndrome, Turner syndrome, neonatal hypoglycemia
- MeSH terms
- Insulin Secretion, Humans, Infant, Newborn, Insulin, Congenital Hyperinsulinism, KATP Channels
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