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Clinical and molecular characterisation of 300 patients with congenital hyperinsulinism
Open accessAbstract
Background: Congenital hyperinsulinism (CHI) is a clinically heterogeneous condition. Mutations in eight genes (ABCC8,KCNJ11,GLUD1,GCK,HADH,SLC16A1,HNF4A and HNF1A) are known to cause CHI. Aim: To characterise the clinical and molecular aspects of a large cohort of patients with CHI. Methodology: Three hundred patients were recruited and clinical information was collected before genotyping.ABCC8 and KCNJ11 genes were analysed in all patients. Mutations in GLUD1,HADH,GCK and HNF4A genes were sought in patients with diazoxide-responsive CHI with hyperammonaemia (GLUD1), raised 3-hydroxybutyrylcarnitine and/or consanguinity (HADH), positive family history (GCK) or when CHI was diagnosed within the first week of life (HNF4A). Results: Mutations were identified in 136/300 patients (45.3%). Mutations in ABCC8/KCNJ11 were the commonest genetic cause identified (n=109, 36.3%). Among diazoxide-unresponsive patients (n=105), mutations in ABCC8/KCNJ11 were identified in 92 (87.6%) patients, of whom 63 patients had recessively inherited mutations while four patients had dominantly inherited mutations. A paternal mutation in the ABCC8/KCNJ11 genes was identified in 23 diazoxide-unresponsive patients, of whom six had diffuse disease. Among the diazoxide-responsive patients (n=183), mutations were identified in 41 patients (22.4%). These include mutations in ABCC8/KCNJ11(n=15),HNF4A(n=7),GLUD1(n=16) and HADH(n=3). Conclusions: A genetic diagnosis was made for 45.3% of patients in this large series. Mutations in the ABCC8 gene were the commonest identifiable cause. The vast majority of patients with diazoxide-responsive CHI (77.6%) had no identifiable mutations, suggesting other genetic and/or environmental mechanisms.
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“A rare pathogenic variant in ABCC8 that causes congenital hyperinsulinism was incorrectly genotyped as homozygous in 43% (9/21) of individuals.”
From Use of SNP chips to detect rare pathogenic variants: retrospective, population based diagnostic evaluation (2021) · cites this paper as [29]
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“A rare pathogenic variant in ABCC8 that causes congenital hyperinsulinism [29] is incorrectly genotyped in 43% (9/21) of individuals.”
From Assessing the analytical validity of SNP-chips for detecting very rare pathogenic variants: implications for direct-to-consumer genetic testing (2019) · cites this paper as [29]
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“Diazoxide is usually ineffective in treating patients with CHI due to biallelic recessive mutations in the genes encoding KATP channel or presence of monoallelic focal form of disease [13,14].”
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“Nevertheless, almost 40% of children with CHI still have unidentified genes to date (3).”
BackgroundHyperinsulinemic Hypoglycemia and Growth Hormone Deficiency Secondary to 20p11 Deletion
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“Given the presentation of congenital hyperinsulinism, targeted next generation sequencing (NGS) with deletion/duplication analysis for 24 genes (ABCC8, AKT2, CACNA1D, CREBBP, EP300, FOXA2, GCK, GLUD1, GPC3, HADH, HNF1A, HNF4A, INSR, KCNJ11, KDM6A, KMT2D, MAFA, MPI, NSD1, PGM1, PMM2, SLC16A1, TRMT10A, and UCP2), which…”
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“HNF4A variants are typically rare and the incidence varies per population but have been described as the third most common cause of diazoxide-responsive CHI in a large cohort of 300 patients with CHI from United Kingdom [14, 15].”
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Congenital Hyperinsulinism of a Large Italian Cohort: A Retrospective Study
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Congenital hyperinsulinism in Gran Canaria, Canary Isles
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Genotyping of ABCC8 , KCNJ11, and HADH in Iranian Infants with Congenital Hyperinsulinism
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“Kapoor et al. demonstrated that among a CHI population who were referred to a children hospital in England, c.331 G > A variant in the ABCC8 gene was one of the most common variants [2].”
A novel mutation in the KCNJ11 gene (p.Val36Glu), predisposes to congenital hyperinsulinemia
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Genotype-histotype-phenotype correlations in hyperinsulinemic hypoglycemia.
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“Additionally, some cases of KATP-associated CHI that develop diabetes despite absence of pancreatic surgery have been reported ( 38, 46, 47 ), indicating the need for long-term follow-up and transition to adult care, regardless of whether continuing treatment for CHI is warranted.”
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Molecular mechanisms of congenital hyperinsulinism and prospective therapeutic targets
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“These patients are mostly responsive to diazoxide [16,27].”
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“Histologically, CHI is classified into focal, diffuse, or atypical forms [11].”
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“Patients with mutations in GLUD1 , HADH , SLC16A1 , HNF1A and HNF4A genes are more likely to be diazoxide-responsive as compared to the other genetic variants (Shaikh et al., 2023; Kapoor et al., 2013; Demirbilek and Hussain, 2017; Flanagan et al., 2010).”
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“However, despite significant advances which have expanded our understanding of the pathophysiology of this disorder, the cause of CHI remains unknown in up to 50% of, patients suggesting the existence of additional genetic loci that have yet to be discovered [54].”
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“Currently, only about half of those who have had targeted genetic testing for HI have received a genetic diagnosis (41, 42).”
Self-citationA Newborn with Congenital Hyperinsulinism
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“4412delT variant of the ABCC8 gene is associated with CHI [11].”
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“Diazoxide is a KATP channel agonist and patients with biallelic mutations in the KATP channel genes usually show a poor response to such treatment [2, 3].”
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Medina, Y. N., García, Á. D., González, S. Q., Garcia-Cruz, L. M., & Santana, A. (2020) · Anales de Pediatría · doi:10.1016/j.anpedi.2020.08.012 · Cited by 2
Functional characterization of inactivating ABCC8 variants causing congenital hyperinsulinism
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Modelling of Beta Cell Pathophysiology Using Stem Cell-Derived Islets
Barsby, T., Montaser, H., Lithovius, V., Ibrahim, H., Vähäkangas, E., Muralidharan, S., Chandra, V., Saarimäki‐Vire, J., & Otonkoski, T. (2023) · Springer eBooks · doi:10.1007/978-3-031-41943-0_24 · Cited by 1
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“In 2013, the p.(Gly111Arg) ABCC8 variant was flagged as a possible founder variant in the Indian population [4].”
Self-citationCells Co-Producing Insulin and Glucagon in Congenital Hyperinsulinism
Krivova, Y. S., Proshchina, A. E., Otlyga, D., Gubaeva, D. N., Melikyan, M. V., & Saveliev, S. V. (2025) · Life · doi:10.3390/life16010018 · Cited by 1
“To date, about 10 monogenic forms and several syndromic forms of CHI are known [1,5], although the molecular causes remain unknown in 21–54% of cases [6,7].”
Qadir, A., Shah, I. A., Mir, M. R., Sofi, J. A., Radha, V., Mohan, V., Ganie, S. A., & Ganie, M. A. (2026) · Clinical Endocrinology · doi:10.1111/cen.70091 · Cited by 1
Comprehensive genetic rescreening improves diagnostic yield in congenital hyperinsulinism
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“In 13 individuals, no genetic cause was identified, consistent with the diagnostic yield reported in other studies [7, 13-16].”
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Self-citationA Case of Late-onset Hyperinsulinemic Hypoglycemia: HNF4A Mutation
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New Tools for Congenital Hyperinsulinism
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“However, in more than half of patients identified with HI, the exact cause is still unknown, which is suggestive of other genetic causes that are yet to be discovered [3].”
BackgroundCongenital Hyperinsulinism and Genetic Disorders of Insulin Resistance and Signalling
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An expanded clinical spectrum of hypoinsulinaemic hypoketotic hypoglycaemia
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“Current aetiological uncertainty in some of the cases we describe is also seen in CHI, which remains a genetically unsolved clinical/metabolic entity in a significant proportion of individuals until today [29, 30].”
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“Previously, CHI was reported as an unusual presentation in Sotos patients (5,23,24), but in recent years the number of studies reporting CHI in this condition has increased (7,8).”
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“The diagnostic criteria included detectable concentration of insulin and/or C peptide in serum when blood glucose is lower than 3mmol/L, with inappropriately low concentration of free fatty acids and ketone bodies [6,12].”
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Self-citationFocal congenital hyperinsulinism resulting from biallelic loss of function of KCNJ11 gene
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Metadata
- Authors
- Kapoor, R. R., Flanagan, S. E., Arya, V. B., Shield, J. P., Ellard, S., & Hussain, K.
- Affiliations
- Great Ormond Street Hospital (GB)
- University of Exeter (GB)
- Corresponding author
- Hussain, Khalid
- Venue
- European Journal of Endocrinology
- Publisher
- Oxford University Press (OUP)
- Published
- 2013-04
- Volume
- 168
- Issue
- 4
- Pages
- 557-564
- ISSN
- 0804-4643 (ISSN-L)
- 1479-683X
- PMC
- PMC3599069
- OpenAlex
- W2111189973
- Semantic Scholar
- 1a21aa2a4c44a96603182b698464b7e013b7884f
- Cited by
- 243
- References
- 81
- Citations by year
- 2026: 14 · 2025: 12 · 2024: 17 · 2023: 19 · 2022: 25 · 2021: 23 · 2020: 21 · 2019: 20 · 2018: 13 · 2017: 12 · 2016: 12 · 2015: 27 · 2014: 22 · 2013: 6
- FWCI
- 22.03
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- European Journal of Endocrinology (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Bristol Research (University of Bristol) (submittedVersion)
- Funders
- Wellcome Trust (081188/A/06/Z)
- Society for Endocrinology
- 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 › Genetics › Genomics and Rare Diseases
- Keywords
- congenital hyperinsulinism, ABCC8, KCNJ11, HNF4α, GLUD1, hydroxyacyl-CoA dehydrogenase, glucokinase, MCT1, genetic diagnosis, recessive inheritance, paternal mutations, diffuse hyperinsulinism, hyperammonemia, consanguinity, genotype-phenotype correlation
- MeSH terms
- Kcnj11 Channel, Diazoxide, Female, Humans, Infant, Infant, Newborn, Male, Mutation, Receptors, Drug, Cohort Studies, ATP-Binding Cassette Transporters, Potassium Channels, Inwardly Rectifying, Congenital Hyperinsulinism, Sulfonylurea Receptors
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