Congenital hyperinsulinism: recent updates on molecular mechanisms, diagnosis and management.
Dinesh GiriKatherine A C HawtonSenthil SenniappanPublished in: Journal of pediatric endocrinology & metabolism : JPEM (2021)
Congenital hyperinsulinism (CHI) is a rare disease characterized by an unregulated insulin release, leading to hypoglycaemia. It is the most frequent cause of persistent and severe hypoglycaemia in the neonatal period and early childhood. Mutations in 16 different key genes (ABCC8, KCNJ11, GLUD1, GCK, HADH, SLC16A1, UCP2, HNF4A, HNF1A, HK1, KCNQ1, CACNA1D, FOXA2, EIF2S3, PGM1 and PMM2) that are involved in regulating the insulin secretion from pancreatic β-cells have been described to be responsible for the underlying molecular mechanisms of CHI. CHI can also be associated with specific syndromes and can be secondary to intrauterine growth restriction (IUGR), maternal diabetes, birth asphyxia, etc. It is important to diagnose and promptly initiate appropriate management as untreated hypoglycaemia can be associated with significant neurodisability. CHI can be histopathologically classified into diffuse, focal and atypical forms. Advances in molecular genetics, imaging techniques (18F-fluoro-l-dihydroxyphenylalanine positron emission tomography/computed tomography scanning), novel medical therapies and surgical advances (laparoscopic pancreatectomy) have changed the management and improved the outcome of patients with CHI. This review article provides an overview of the background, clinical presentation, diagnosis, molecular genetics and therapy for children with different forms of CHI.
Keyphrases
- positron emission tomography
- computed tomography
- type diabetes
- high resolution
- cardiovascular disease
- healthcare
- magnetic resonance imaging
- glycemic control
- induced apoptosis
- pet imaging
- young adults
- single molecule
- early onset
- adipose tissue
- inflammatory response
- genome wide
- physical activity
- transcription factor
- cell death
- metabolic syndrome
- pregnant women
- dual energy
- image quality
- skeletal muscle
- body mass index
- contrast enhanced
- robot assisted
- minimally invasive
- mass spectrometry
- nuclear factor
- photodynamic therapy