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PSUN340 Two cases of diffuse form of diazoxide-responsive congenital hyperinsulinism confirmed by 18F-DOPA PET-CT

INTRODUCTION: Congenital hyperinsulinism is one of the most common causes of severe hypoglycemia in infants. Brain can be more damaged in the situation of hypoketotic hypoglycemia because there are no sufficient ketones for brain metabolism. Some patients develop severe symptoms during the newborn p...

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Autores principales: Yu, Jeesuk, Yang, Jaejin, Son, Hye Joo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Oxford University Press 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9627314/
http://dx.doi.org/10.1210/jendso/bvac150.865
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author Yu, Jeesuk
Yang, Jaejin
Son, Hye Joo
author_facet Yu, Jeesuk
Yang, Jaejin
Son, Hye Joo
author_sort Yu, Jeesuk
collection PubMed
description INTRODUCTION: Congenital hyperinsulinism is one of the most common causes of severe hypoglycemia in infants. Brain can be more damaged in the situation of hypoketotic hypoglycemia because there are no sufficient ketones for brain metabolism. Some patients develop severe symptoms during the newborn period, others at a later age. Several genes including ABCC8, KCNJ11, GCK, GLUD1, and HNF1A are reported as the candidate genes of congenital hyperinsulinism and 18F-DOPA PET-CT can be used to detect the location. CLINICAL CASES: Case 1. A 9-year-old girl, born at 38 weeks, 3.12 kg, without any perinatal problems, developed hypoglycemic seizure at the age of 65 days for the first time. The levels of blood glucose, insulin, C-peptide, cortisol, and ammonia were 42 mg/dL, 37.14<img src="data: image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAAoAAAARCAIAAABrQaqyAAAAAXNSR0IArs4c6QAAAAlwSFlzAAAOxAAADsQBlSsOGwAAAF5JREFUKFNj/P//PwNuwIRHDig1RKTvTLRmTN8O9sr2dEbriXfo7PIrt4A23tm+4Qo0NIFhDgO3J1gBAQODVdq229vSgPJWaQxo0hNuIwn8/48W5seu3UaJI0aKIhQA19xAJDTBqMgAAAAASUVORK5CYII=">U/mL, 4.20 ng/mL, 21.85 ug/dL and 54 ug/dL, respectively. Diazoxide was started and she was referred to our institute at 9 months old. The levels of glucose, insulin, and C-peptide, and cortisol performed at the age of 13 months with medication of diazoxide (7.7 mg/kg/day) were 4 7mg/dL, 5.5 <img src="data: image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAAcAAAARCAIAAACevyECAAAAAXNSR0IArs4c6QAAAAlwSFlzAAAOxAAADsQBlSsOGwAAAFtJREFUKFNj/P//PwMGYMIUAorQXfTORGvG9O1gt2xPZ7SeeIeKbrhyC2jane0brkC9+v//7QlWQMDAYJW27fa2NKCwVRoDRHTCbWAoIQAkHI5du40SSowkhCQAYbsuNpK0C5QAAAAASUVORK5CYII=">IU/mL, and 0.7 ng/mL, and 32.4 ug/dL, respectively. She admitted several times due to hypoglycemia which associated with poor oral intake during acute febrile illness. Diazoxide dosage had been increased according to the situation until 7 years old. Genetic investigation including whole exome sequencing did not show any pathogenic mutation. She grew well and showed normal development. Now she is on diazoxide medication but the dosage can be reduced to 3.7 mg/kg/day. 18F-DOPA PET-CT was performed to see the pathologic extent which revealed diffusely increased uptake from head to tail of pancreas. Case 2. A 25-month-old boy, born at 37+3 weeks, 2.9 kg, without any perinatal problems, was diagnosed with epilepsy at the age of 6 months. Hypoglycemic seizure was first identified at the age of 11 months when he was admitted to our institute due to severe hypoglycemia combined with seizure. The levels of blood glucose, insulin, C-peptide, cortisol and ammonia were 35 mg/dL, <img src="data: image/png;base64,iVBORw0KGgoAAAANSUhEUgAAACMAAAARCAIAAADYCYKoAAAAAXNSR0IArs4c6QAAAAlwSFlzAAAOxAAADsQBlSsOGwAAAMBJREFUSEvdVcENwyAMhI5l9sHrhE36gg0yAcojsAt1EmhIZQVFVfLAL3w6Y+t8CJlSEo/E65EuS5OeO0VnUKE7asmCNaVJqMikXnSIGObJjxXOgscmTNXp0sl7a4QBhLYlOwNrDlv1c0lOb3JENErmXTiUysS+vXf/A764JxK96N+czc+0nejePjNX22kodQB6CJsXGTBZLYpDecJuWgC6FLQNSw0dBG/Jf1FyP2wTf+Oiek3JdsI4hQNbdvhrfACYFi2Z8Bo2twAAAABJRU5ErkJggg==">U/mL, 2.9 ng/mL, 18.5 ug/dL and 40.4 ug/dL, respectively. Diazoxide was added to the antiseizure medication. He admitted several times due to seizure which was not associated with hypoglycemia. He also showed global developmental delay. Now he is still on diazoxide medication with dosage of 6.4 mg/kg/day. 18F-DOPA PET-CT revealed diffusely increased uptake from head to tail of pancreas. CONCLUSION: Here we report two cases of diffuse form of diazoxide-responsive congenital hyperinsulinism confirmed by 18F-DOPA PET-CT. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
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spelling pubmed-96273142022-11-03 PSUN340 Two cases of diffuse form of diazoxide-responsive congenital hyperinsulinism confirmed by 18F-DOPA PET-CT Yu, Jeesuk Yang, Jaejin Son, Hye Joo J Endocr Soc Diabetes & Glucose Metabolism INTRODUCTION: Congenital hyperinsulinism is one of the most common causes of severe hypoglycemia in infants. Brain can be more damaged in the situation of hypoketotic hypoglycemia because there are no sufficient ketones for brain metabolism. Some patients develop severe symptoms during the newborn period, others at a later age. Several genes including ABCC8, KCNJ11, GCK, GLUD1, and HNF1A are reported as the candidate genes of congenital hyperinsulinism and 18F-DOPA PET-CT can be used to detect the location. CLINICAL CASES: Case 1. A 9-year-old girl, born at 38 weeks, 3.12 kg, without any perinatal problems, developed hypoglycemic seizure at the age of 65 days for the first time. The levels of blood glucose, insulin, C-peptide, cortisol, and ammonia were 42 mg/dL, 37.14<img src="data: image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAAoAAAARCAIAAABrQaqyAAAAAXNSR0IArs4c6QAAAAlwSFlzAAAOxAAADsQBlSsOGwAAAF5JREFUKFNj/P//PwNuwIRHDig1RKTvTLRmTN8O9sr2dEbriXfo7PIrt4A23tm+4Qo0NIFhDgO3J1gBAQODVdq229vSgPJWaQxo0hNuIwn8/48W5seu3UaJI0aKIhQA19xAJDTBqMgAAAAASUVORK5CYII=">U/mL, 4.20 ng/mL, 21.85 ug/dL and 54 ug/dL, respectively. Diazoxide was started and she was referred to our institute at 9 months old. The levels of glucose, insulin, and C-peptide, and cortisol performed at the age of 13 months with medication of diazoxide (7.7 mg/kg/day) were 4 7mg/dL, 5.5 <img src="data: image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAAcAAAARCAIAAACevyECAAAAAXNSR0IArs4c6QAAAAlwSFlzAAAOxAAADsQBlSsOGwAAAFtJREFUKFNj/P//PwMGYMIUAorQXfTORGvG9O1gt2xPZ7SeeIeKbrhyC2jane0brkC9+v//7QlWQMDAYJW27fa2NKCwVRoDRHTCbWAoIQAkHI5du40SSowkhCQAYbsuNpK0C5QAAAAASUVORK5CYII=">IU/mL, and 0.7 ng/mL, and 32.4 ug/dL, respectively. She admitted several times due to hypoglycemia which associated with poor oral intake during acute febrile illness. Diazoxide dosage had been increased according to the situation until 7 years old. Genetic investigation including whole exome sequencing did not show any pathogenic mutation. She grew well and showed normal development. Now she is on diazoxide medication but the dosage can be reduced to 3.7 mg/kg/day. 18F-DOPA PET-CT was performed to see the pathologic extent which revealed diffusely increased uptake from head to tail of pancreas. Case 2. A 25-month-old boy, born at 37+3 weeks, 2.9 kg, without any perinatal problems, was diagnosed with epilepsy at the age of 6 months. Hypoglycemic seizure was first identified at the age of 11 months when he was admitted to our institute due to severe hypoglycemia combined with seizure. The levels of blood glucose, insulin, C-peptide, cortisol and ammonia were 35 mg/dL, <img src="data: image/png;base64,iVBORw0KGgoAAAANSUhEUgAAACMAAAARCAIAAADYCYKoAAAAAXNSR0IArs4c6QAAAAlwSFlzAAAOxAAADsQBlSsOGwAAAMBJREFUSEvdVcENwyAMhI5l9sHrhE36gg0yAcojsAt1EmhIZQVFVfLAL3w6Y+t8CJlSEo/E65EuS5OeO0VnUKE7asmCNaVJqMikXnSIGObJjxXOgscmTNXp0sl7a4QBhLYlOwNrDlv1c0lOb3JENErmXTiUysS+vXf/A764JxK96N+czc+0nejePjNX22kodQB6CJsXGTBZLYpDecJuWgC6FLQNSw0dBG/Jf1FyP2wTf+Oiek3JdsI4hQNbdvhrfACYFi2Z8Bo2twAAAABJRU5ErkJggg==">U/mL, 2.9 ng/mL, 18.5 ug/dL and 40.4 ug/dL, respectively. Diazoxide was added to the antiseizure medication. He admitted several times due to seizure which was not associated with hypoglycemia. He also showed global developmental delay. Now he is still on diazoxide medication with dosage of 6.4 mg/kg/day. 18F-DOPA PET-CT revealed diffusely increased uptake from head to tail of pancreas. CONCLUSION: Here we report two cases of diffuse form of diazoxide-responsive congenital hyperinsulinism confirmed by 18F-DOPA PET-CT. Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m. Oxford University Press 2022-11-01 /pmc/articles/PMC9627314/ http://dx.doi.org/10.1210/jendso/bvac150.865 Text en © The Author(s) 2022. Published by Oxford University Press on behalf of the Endocrine Society. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com
spellingShingle Diabetes & Glucose Metabolism
Yu, Jeesuk
Yang, Jaejin
Son, Hye Joo
PSUN340 Two cases of diffuse form of diazoxide-responsive congenital hyperinsulinism confirmed by 18F-DOPA PET-CT
title PSUN340 Two cases of diffuse form of diazoxide-responsive congenital hyperinsulinism confirmed by 18F-DOPA PET-CT
title_full PSUN340 Two cases of diffuse form of diazoxide-responsive congenital hyperinsulinism confirmed by 18F-DOPA PET-CT
title_fullStr PSUN340 Two cases of diffuse form of diazoxide-responsive congenital hyperinsulinism confirmed by 18F-DOPA PET-CT
title_full_unstemmed PSUN340 Two cases of diffuse form of diazoxide-responsive congenital hyperinsulinism confirmed by 18F-DOPA PET-CT
title_short PSUN340 Two cases of diffuse form of diazoxide-responsive congenital hyperinsulinism confirmed by 18F-DOPA PET-CT
title_sort psun340 two cases of diffuse form of diazoxide-responsive congenital hyperinsulinism confirmed by 18f-dopa pet-ct
topic Diabetes & Glucose Metabolism
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9627314/
http://dx.doi.org/10.1210/jendso/bvac150.865
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