二例GCK基因突变致先天性高胰岛素性低血糖症的诊疗和基因检测分析
收稿日期: 2022-06-30
修回日期: 2022-09-06
网络出版日期: 2022-09-29
基金资助
国家自然科学基金项目(82170855);科技部国家重点研发计划项目(2020YFC2004505);科技部国家重点研发计划项目(2018YFC2001105)
Diagnosis, treatment and genetic analysis of two cases of congenital hyperinsulinemic hypoglycemia caused by GCK gene mutation
Received date: 2022-06-30
Revised date: 2022-09-06
Online published: 2022-09-29
Supported by
the National Natural Science Foundation of China(82170855);the National Key Research and Development Program(2020YFC2004505);the National Key Research and Development Program(2018YFC2001105)
先天性高胰岛素血症(congenital hyperinsulinemia, CHI)是一组由胰腺β细胞不适当分泌胰岛素引起持续低血糖的异质性疾病。迄今发现15种基因突变与CHI相关。编码葡萄糖激酶(glucokinase, GCK)基因突变引起的葡萄糖激酶型高胰岛素血症(GCK-CHI)为CHI的罕见类型。本文主要报道了收集到的2例GCK-CHI患者的临床资料和基因检测结果。通过总结2例患者的病例特点及其基因检测分析发现,对于临床上反复发作持续性低血糖的患者要考虑CHI。在这部分患者当中进行基因检测有助于避免误诊,提供治疗策略,改善预后。
贾觉睿智, 肖诚, 刘艺文, 李冉, 张化冰, 于淼 . 二例GCK基因突变致先天性高胰岛素性低血糖症的诊疗和基因检测分析[J]. 遗传, 2022 , 44(11) : 1056 -1062 . DOI: 10.16288/j.yczz.22-226
Congenital hyperinsulinemia (CHI) is a heterogeneous disorder characterized by persistent hypoglycemia due to inappropriate insulin secretion. A total of 15 gene mutations have already been reported to be associated with CHI. Among them, CHI caused by the GCK mutation is named GCK-CHI, which is considered to be a rare form of CHI. Here, we reported two cases of GCK-CHI diagnosed by genetic testing and summarized the clinical characteristics. In patients with recurrent or persistent hypoglycemia, CHI should be taken into consideration. Genetic testing should be perfomed in these patients to avoid misdiagnosis and provide accurate intervention, thus to improve prognosis.
Key words: congenital hyperinsulinemic; hypoglycemia; GCK gene mutation
| [1] | Galcheva S, Demirbilek H, Al-Khawaga S, Hussain K. The genetic and molecular mechanisms of congenital hyperinsulinism. Front Endocrinol (Lausanne), 2019, 10: 111. |
| [2] | Saint-Martin C, Arnoux JB, de Lonlay P, Bellanné- Chantelot C. KATP channel mutations in congenital hyperinsulinism. Semin Pediatr Surg, 2011, 20(1): 18-22. |
| [3] | Lu M, Li CH. Nutrient sensing in pancreatic islets: lessons from congenital hyperinsulinism and monogenic diabetes. Ann N Y Acad Sci, 2018, 1411(1): 65-82. |
| [4] | Glaser B, Kesavan P, Heyman M, Davis E, Cuesta A, Buchs A, Stanley CA, Thornton PS, Permutt MA, Matschinsky FM, Herold KC. Familial hyperinsulinism caused by an activating glucokinase mutation. N Engl J Med, 1998, 338(4): 226-230. |
| [5] | Osbak KK, Colclough K, Saint-Martin C, Beer NL, Bellanné-Chantelot C, Ellard S, Gloyn AL. Update on mutations in glucokinase (GCK), which cause maturity- onset diabetes of the young, permanent neonatal diabetes, and hyperinsulinemic hypoglycemia. Hum Mutat, 2009, 30(11): 1512-1526. |
| [6] | Christesen HBT, Jacobsen BB, Odili S, Buettger C, Cuesta-Munoz A, Hansen T, Brusgaard K, Massa O, Magnuson MA, Shiota C, Matschinsky FM, Barbetti F. The second activating glucokinase mutation (A456V): implications for glucose homeostasis and diabetes therapy. Diabetes, 2002, 51(4): 1240-1246. |
| [7] | Galcheva S, Al-Khawaga S, Hussain K. Diagnosis and management of hyperinsulinaemic hypoglycaemia. Best Pract Res Clin Endocrinol Metab, 2018, 32(4): 551-573. |
| [8] | Palladino AA, Bennett MJ, Stanley CA. Hyperinsulinism in infancy and childhood: when an insulin level is not always enough. Clin Chem, 2008, 54(2): 256-263. |
| [9] | Ferrara C, Patel P, Becker S, Stanley CA, Kelly A. Biomarkers of insulin for the diagnosis of hyperinsulinemic hypoglycemia in infants and children. J Pediatr, 2016, 168: 212-219. |
| [10] | Froguel P, Vaxillaire M, Sun F, Velho G, Zouali H, Butel MO, Lesage S, Vionnet N, Clément K, Fougerousse F, Tanizawa Y, Weissenbach J, Beckmann JS, Lathrop GM, Passa P, Permutt MA, Cohen D. Close linkage of glucokinase locus on chromosome 7p to early-onset non-insulin- dependent diabetes mellitus. Nature, 1992, 356(6365): 162-164. |
| [11] | Iynedjian PB, M?bius G, Seitz HJ, Wollheim CB, Renold AE. Tissue-specific expression of glucokinase: identification of the gene product in liver and pancreatic islets. Proc Natl Acad Sci USA, 1986, 83(7): 1998-2001. |
| [12] | Nessa A, Rahman SA, Hussain K. Hyperinsulinemic hypoglycemia-the molecular mechanisms. Front Endocrinol (Lausanne), 2016, 7: 29. |
| [13] | Christesen HBT, Tribble ND, Molven A, Siddiqui J, Sandal T, Brusgaard K, Ellard S, Nj?lstad PR, Alm J, Jacobsen BB, Hussain K, Gloyn AL. Activating glucokinase (GCK) mutations as a cause of medically responsive congenital hyperinsulinism: prevalence in children and characterisation of a novel GCK mutation. Eur J Endocrinol, 2008, 159(1): 27-34. |
| [14] | Gilis-Januszewska A, Bogus?awska A, Kowalik A, Rzepka E, Soczówka K, Przybylik-Mazurek E, G?owa B, Hubalewska-Dydejczyk A. Hyperinsulinemic hypoglycemia in three generations of a family with glucokinase activating mutation, c.295T>C (p.Trp99Arg). Genes (Basel), 2021, 12(10): 1566. |
| [15] | Koneshamoorthy A, Seniveratne-Epa D, Calder G, Sawyer M, Kay TWH, Farrell S, Loudovaris T, Mariana L, McCarthy D, Lyu R, Liu X, Thorn P, Tong J, Chin LK, Zacharin M, Trainer A, Taylor S, MacIsaac RJ, Sachithanandan N, Thomas HE, Krishnamurthy B. Case report: hypoglycemia due to a novel activating glucokinase variant in an adult-a molecular approach. Front Endocrinol (Lausanne), 2022, 13: 842937. |
| [16] | Sternisha SM, Liu PL, Marshall AG, Miller BG. Mechanistic origins of enzyme activation in human glucokinase variants associated with congenital hyperinsulinism. Biochemistry, 2018, 57(10): 1632-1639. |
| [17] | Gloyn AL, Noordam K, Willemsen MAAP, Ellard S, Lam WWK, Campbell IW, Midgley P, Shiota C, Buettger C, Magnuson MA, Matschinsky FM, Hattersley AT. Insights into the biochemical and genetic basis of glucokinase activation from naturally occurring hypoglycemia mutations. Diabetes, 2003, 52(9): 2433-2340. |
| [18] | Kamata K, Mitsuya M, Nishimura T, Eiki JI, Nagata Y. Structural basis for allosteric regulation of the monomeric allosteric enzyme human glucokinase. Structure, 2004, 12(3): 429-438. |
| [19] | Sayed S, Langdon DR, Odili S, Chen P, Buettger C, Schiffman AB, Suchi M, Taub R, Grimsby J, Matschinsky FM, Stanley CA. Extremes of clinical and enzymatic phenotypes in children with hyperinsulinism caused by glucokinase activating mutations. Diabetes, 2009, 58(6): 1419-1427. |
| [20] | Whittington AC, Larion M, Bowler JM, Ramsey KM, Brüschweiler R, Miller BG. Dual allosteric activation mechanisms in monomeric human glucokinase. Proc Natl Acad Sci USA, 2015, 112(37): 11553-11558. |
| [21] | Martínez R, Gutierrez-Nogués á, Fernández-Ramos C, Velayos T, Vela A, Spanish Congenital Hyperinsulinism Group, Navas Má, Casta?o L. Heterogeneity in phenotype of hyperinsulinism caused by activating glucokinase mutations: a novel mutation and its functional characterization. Clin Endocrinol (Oxf), 2017, 86(6): 778-783. |
| [22] | Maiorana A, Caviglia S, Greco B, Alfieri P, Cumbo F, Campana C, Bernabei SM, Cusmai R, Mosca A, Dionisi- Vici C. Ketogenic diet as elective treatment in patients with drug-unresponsive hyperinsulinemic hypoglycemia caused by glucokinase mutations. Orphanet J Rare Dis, 2021, 16(1): 424. |
| [23] | Li LY, Liu SQ, Shi Y, Zheng S, Zhao CC, Zheng XQ. Diagnosis, treatment and genetic analysis of a case of hypoglycemia caused by glucokinase gene mutation. Hereditas(Beijing), 2022, 44(9): 810-818. |
| [23] | 李璐阳, 刘孙强, 施云, 赵成程, 周红文, 郑旭琴. 一例葡萄糖激酶基因突变致低血糖症的诊疗及家系遗传分析. 遗传, 2022, 44(9): 810-818.. |
| [24] | Snider KE, Becker S, Boyajian L, Shyng SL, MacMullen C, Hughes N, Ganapathy K, Bhatti T, Stanley CA, Ganguly A. Genotype and phenotype correlations in 417 children with congenital hyperinsulinism. J Clin Endocrinol Metab, 2013, 98(2): E355-E363. |
| [25] | Hussain K. Diagnosis and management of hyperinsulinaemic hypoglycaemia of infancy. Horm Res, 2008, 69(1): 2-13. |
| [26] | Güemes M, Hussain K. Hyperinsulinemic hypoglycemia. Pediatr Clin North Am, 2015, 62(4): 1017-1036. |
| [27] | Müller D, Zimmering M, Roehr CC. Should nifedipine be used to counter low blood sugar levels in children with persistent hyperinsulinaemic hypoglycaemia? Arch Dis Child, 2004, 89(1): 83-85. |
| [28] | Mohnike K, Blankenstein O, Pfuetzner A, P?tzsch S, Schober E, Steiner S, Hardy OT, Grimberg A, van Waarde WM. Long-term non-surgical therapy of severe persistent congenital hyperinsulinism with glucagon. Horm Res, 2008, 70(1): 59-64. |
| [29] | Senniappan S, Alexandrescu S, Tatevian N, Shah P, Arya V, Flanagan S, Ellard S, Rampling D, Ashworth M, Brown RE, Hussain K. Sirolimus therapy in infants with severe hyperinsulinemic hypoglycemia. N Engl J Med, 2014, 370(12): 1131-1137. |
| [30] | Hernandez-Pampaloni M, Zhuang HM, Fanti S, Alavi A. Positron emission tomography imaging and hyperinsulinism. PET Clin, 2007, 2(3): 377-383. |
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