Persistent congenital hyperinsulinism in two patients with Beckwith-Wiedemann syndrome due to mosaic uniparental disomy 11p
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Yuri A. Zarate
, Natasha Shur
Abstract
Congenital hyperinsulinism (CHI) is a rare metabolic disease characterized by inappropriate insulin secretion in the presence of hypoglycemia. We describe the clinical presentation and management of congenital hyperinsulinism and persistent hypoglycemia in two infants. Both patients had an initial clinical diagnosis of Beckwith-Wiedemann syndrome (BWS) but normal methylation analysis for LIT1 and H19 status. Both patients were eventually found to have mosaic uniparental disomy 11p diagnosed by single nucleotide polymorphism (SNP) array in DNA isolated from lymphoblasts and fibroblasts, respectively. We report that patients with mosaic BWS are at increased risk for both transient and refractory hypoglycemia that may need aggressive management with diazoxide, octreotide, high glucose infusion rates, and a frequent feeding regime. Our patient experience supports the case for pursuing further testing in patients with features of BWS with normal methylation studies, karyotype, and SNP arrays on blood. The next logical step is SNP array on skin biopsy to rule out mosaicism.
References
1. Adachi H, Takahashi I, Higashimoto K, Tsuchida S, Noguchi A, et al. Congenital hyperinsulinism in an infant with paternal uniparental disomy on chromosome 11p15: few clinical features suggestive of Beckwith-Wiedemann syndrome. Endocr J 2013;60:403–8.10.1507/endocrj.EJ12-0242Suche in Google Scholar PubMed
2. Damaj L, le Lorch M, Verkarre V, Werl C, Hubert L, et al. Chromosome 11p15 paternal isodisomy in focal forms of neonatal hyperinsulinism. J Clin Endocrinol Metab 2008;93:4941–7.10.1210/jc.2008-0673Suche in Google Scholar PubMed
3. Giurgea I, Sanlaville D, Fournet JC, Sempoux C, Bellanne- Chantelot C, et al. Congenital hyperinsulinism and mosaic abnormalities of the ploidy. J Med Genet 2006;43:248–54.10.1136/jmg.2005.034116Suche in Google Scholar PubMed PubMed Central
4. Glaser B, Ryan F, Donath M, Landau H, Stanley CA, et al. Hyperinsulinism caused by paternal-specific inheritance of a recessive mutation in the sulfonylurea-receptor gene. Diabetes 1999;48:1652–7.10.2337/diabetes.48.8.1652Suche in Google Scholar PubMed
5. Hussain K, Flanagan SE, Smith VV, Ashworth M, Day M, et al. An ABCC8 gene mutation and mosaic uniparental isodisomy resulting in atypical diffuse congenital hyperinsulinism. Diabetes 2008;57:259–63.10.2337/db07-0998Suche in Google Scholar PubMed
6. Arnoux JB, de Lonlay P, Ribeiro MJ, Hussain K, Blankenstein O, et al. Congenital hyperinsulinism. Early Hum Dev 2010;86: 287–94.10.1016/j.earlhumdev.2010.05.003Suche in Google Scholar PubMed
7. Arnoux JB, Verkarre V, Saint-Martin C, Montravers F, Brassier A, et al. Congenital hyperinsulinism: current trends in diagnosis and therapy. Orphanet J Rare Dis 2011;6:63.10.1186/1750-1172-6-63Suche in Google Scholar PubMed PubMed Central
8. Weksberg R, Shuman C, Beckwith JB. Beckwith-Wiedemann syndrome. Eur J Hum Genet 2010;18:8–14.10.1038/ejhg.2009.106Suche in Google Scholar PubMed PubMed Central
9. Hussain K, Cosgrove KE, Shepherd RM, Luharia A, Smith VV, et al. Hyperinsulinemic hypoglycemia in Beckwith-Wiedemann syndrome due to defects in the function of pancreatic beta-cell adenosine triphosphate-sensitive potassium channels. J Clin Endocrinol Metab 2005;90:4376–82.10.1210/jc.2005-0158Suche in Google Scholar PubMed
10. Choufani S, Shuman C, Weksberg R. Molecular findings in Beckwith-Wiedemann syndrome. Am J Med Genet C Semin Med Genet 2013;163:131–40.10.1002/ajmg.c.31363Suche in Google Scholar PubMed
11. Keren B, Chantot-Bastaraud S, Brioude F, Mach C, Fonteneau E, et al. SNP arrays in Beckwith-Wiedemann syndrome: an improved diagnostic strategy. Eur J Med Genet 2013;56:546–50.10.1016/j.ejmg.2013.06.005Suche in Google Scholar
12. Azzi S, Steunou V, Rousseau A, Rossignol S, Thibaud N, et al. Allele-specific methylated multiplex real-time quantitative PCR (ASMM RTQ-PCR), a powerful method for diagnosing loss of imprinting of the 11p15 region in Russell Silver and Beckwith Wiedemann syndromes. Hum Mutat 2011;32:249–58.10.1002/humu.21403Suche in Google Scholar
13. Kalish JM, Conlin LK, Mostoufi-Moab S, Wilkens AB, Mulchandani S, et al. Bilateral pheochromocytomas, hemihyperplasia, and subtle somatic mosaicism: the importance of detecting low-level uniparental disomy. Am J Med Genet A 2013;161A:993–1001.10.1002/ajmg.a.35831Suche in Google Scholar
14. Brioude F, Lacoste A, Netchine I, Vazquez MP, Auber F, et al. Beckwith-Wiedemann syndrome: growth pattern and tumor risk according to molecular mechanism, and guidelines for tumor surveillance. Horm Res Paediatr 2013;80:457–65.10.1159/000355544Suche in Google Scholar
15. DeBaun MR, King AA, White N. Hypoglycemia in Beckwith-Wiedemann syndrome. Semin Perinatol 2000;24:164–71.10.1053/sp.2000.6366Suche in Google Scholar
16. Fournet JC, Mayaud C, de Lonlay P, Gross-Morand MS, Verkarre V, et al. Unbalanced expression of 11p15 imprinted genes in focal forms of congenital hyperinsulinism: association with a reduction to homozygosity of a mutation in ABCC8 or KCNJ11. Am J Pathol 2001;158:2177–84.10.1016/S0002-9440(10)64689-5Suche in Google Scholar
©2014 by De Gruyter
Artikel in diesem Heft
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Artikel in diesem Heft
- Frontmatter
- Review article
- Towards an optimization of the management of endocrine complications of thalassemia
- Original articles
- The natural course of Hashimoto’s thyroiditis in children and adolescents
- Muscle strength and body composition during the transition phase in patients treated with recombinant GH to final height
- Benign vaginal bleeding in 24 prepubertal patients: clinical, biochemical and imaging features
- Evaluation of epicardial adipose tissue, carotid intima-media thickness and ventricular functions in obese children and adolescents
- Counseling patients with succinate dehydrogenase subunit defects: genetics, preventive guidelines, and dealing with uncertainty
- Pubertal development profile in patients with Turner syndrome
- A novel CASR mutation associated with neonatal severe hyperparathyroidism transmitted as an autosomal recessive disorder
- Serum insulin-like growth factor-binding protein-3 level correlated with glycemic control and lipid profiles in children and adolescents with type 1 diabetes
- Adult human liver mesenchymal progenitor cells express phenylalanine hydroxylase
- Clinical applicability of rapid detection of SRY and DYS14 genes in patients with disorders of sex development using an indigenously developed 5′ exonuclease based assay
- Hereditary 1,25-dihydroxyvitamin D-resistant rickets with alopecia in four Egyptian families: report of three novel mutations in the vitamin D receptor gene
- Permanent neonatal diabetes mellitus in Jordan
- The effect of adenotonsilectomy on ghrelin, leptin, IGF-1 levels and growth parameters in children with adenotonsillar hypertrophy
- The role of anti-Mullerian and inhibin B hormones in the evaluation of 46,XY disorders of sex development
- The evaluation of thyroid carcinoma in childhood and concomitance of autoimmune thyroid disorders
- Lipid patterns in treated growth hormone deficient children vs. short stature controls
- Assessment of aortic morphology and compliance in children and adolescents with Ullrich-Turner syndrome (UTS) using magnetic resonance imaging (MRI)
- Management of central diabetes insipidus with oral desmopressin lyophilisate in infants
- Maternal factors and complications of preterm birth associated with neonatal thyroid stimulating hormone
- Patient reports
- A rare case of pituitary infarction leading to spontaneous tumour resolution and CSF-sella syndrome in an 11-year-old girl and a review of the paediatric literature
- Rare case of homozygous epimerase deficiency and heterozygous of duarte 2 variant
- Persistent congenital hyperinsulinism in two patients with Beckwith-Wiedemann syndrome due to mosaic uniparental disomy 11p
- Growth hormone treatment in a patient with Hurler-Scheie syndrome
- Neonatal diagnosis of a patient with hypoparathyroidism, sensorineural deafness and renal dysplasia (HDR) syndrome associated with cerebral infarction
- Early-onset diabetes mellitus and neurodevelopmental retardation: the first Greek case of Wolcott-Rallison syndrome
- Type III Bartter-like syndrome in an infant boy with Gitelman syndrome and autosomal dominant familial neurohypophyseal diabetes insipidus
- Cushing’s syndrome: hidden risk in usage of topical corticosteroids
- Prader-Willi syndrome: a case report with atypical developmental features
- Berardinelli-Seip congenital lipodystrophy: an autosomal recessive disorder with rare association of duodenocolonic polyps
- Ectopic Cushing syndrome secondary to metastatic medullary thyroid cancer in a child with multiple endocrine neoplasia syndrome type 2B: clues to early diagnosis of the paraneoplastic syndromes
- Ovarian hyperstimulation syndrome treated by medroxyprogesterone acetate
- Symptomatic cerebral infarction in a child with severe diabetic ketoacidosis
- A rare case of familial Cushing’s syndrome with a common presentation of weight gain due to a mutation of the PRKAR1A gene causing isolated primary pigmented nodular adrenocortical disease
- Multiple autoimmunity, type 1 diabetes (T1DM), autoimmune thyroiditis and thyroid cancer: is there an association? A case report and literature review
- Cholestasis and protein-losing enteropathy secondary to hyperthyroidism in a 6-year-old girl
- Short communication
- An essential splice site mutation (c.317+1G>A) in the TSHR gene leads to severe thyroid dysgenesis
- Letter to the Editor
- Pubertal gynecomastia: what about the remaining 10%?