Saturday 24 April 2004
Congenital hyperinsulinism (CHI) is biochemically characterised by the dysregulated secretion of insulin from pancreatic beta-cells. It is a major cause of persistent hyperinsulinaemic hypoglycaemia (HH) in the newborn and infancy period.
Genetically CHI is a heterogeneous condition with mutations in seven different genes described. The genetic basis of CHI involves defects in key genes which regulate insulin secretion from beta-cells.
Recessive inactivating mutations in ABCC8 and KCNJ11 (which encode the two subunits of the adenosine triphosphate sensitive potassium channels (ATP sensitive K(ATP) channels)) in beta-cells are the most common cause of CHI.
The other recessive form of CHI is due to mutations in HADH (encoding for-3-hydroxyacyl-coenzyme A dehydrogenase).
Dominant forms of CHI are due to inactivating mutations in ABCC8 and KCNJ11, and activating mutations in GLUD1 (encoding glutamate dehydrogenase) and GCK (encoding glucokinase).
Recently dominant mutations in HNF4A (encoding hepatocyte nuclear factor 4alpha) and SLC16A1 (encoding monocarboxylate transporter 1) have been described which lead to HH.
Mutations in all these genes account for about 50% of the known causes of CHI.
Histologically there are three (possibly others which have not been characterised yet) major subtypes of CHI: diffuse, focal and atypical forms.
The diffuse form is inherited in an autosomal recessive (or dominant manner), the focal form being sporadic in inheritance.
The diffuse form of the disease may require a near total pancreatectomy whereas the focal form requires a limited pancreatectomy potentially curing the patient.
KATP channel-associated hyperinsulinsm (KATP-CHI, ABCC8-CHI, KCNJ11-CHI)
- focal adenomatous hyperinsulism (focal form)
- diffuse hyperinsulinism
- recessive diffuse hyperinsulinism
- dominant diffuse hyperinsulinism (#12941782#, #11018078#)
hyperinsulinism/hyperammonemia syndrome (HI/HA or GDH-CHI)
glucokinase-associated CHI (GK-CHI)
SCHAD-associated CHI (short-chain 3-hydroxyacyl-CoA dehydrogenase) (SCHAD-CHI) (#14693719#)
congenital disorders of glycosylation (CDGs)
- hyperinsulinemic hypoglycemia in congenital disorder of glycosylation Ia (CDG-Ia)
- hyperinsulinemic hypoglycemia in congenital disorder of glycosylation Ib (CDG-Ib) (#12872847#)
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Surgical versus non-surgical treatment of congenital hyperinsulinism. Mazor-Aronovitch K, Landau H, Gillis D. Pediatr Endocrinol Rev. 2009 Mar;6(3):424-30. PMID: #19396028#
Laparoscopic pancreatectomy for persistent hyperinsulinemic hypoglycemia of infancy. Al-Shanafey S, Habib Z, AlNassar S. J Pediatr Surg. 2009 Jan;44(1):134-8; discussion 138. PMID: #19159730#