Congenital hyperinsulinemic hypoglycemia with a new HADH mutation and pancreatic overexpression of GLP-1 receptors.

Background: The most common cause of endogenous hyperinsulinemic hypoglycemia in neonates (congenital hyperinsulinemic hypoglycemia; CHH) are different monogenic form of gene mutations. About 50% of the mutations are known. We present a new mutation within the short-chain L-3-hydroxyacyl-CoA dehydrogenase (HADH) gene causing CHH in two related patients.

Methods: The course of two consanguineous patients with CHH are presented with a follow-up of >30 years. NextSeq 500 sequencing was performed and confined on known genes with autosomal recessive inheritance, namely ABCC8 (MANE Select: NM_00352.6), HADH (MANE Select: NM_005327.7) and KCNJ11 (MANE Select: NM_00525.4). Acylcarnitine-profiles were measured and 68Ga-DOTA Exendin PET/CT was performed.

Results: CHH was diagnosed in both patients in the neonatal period. A therapy with Diazoxid was initiated, which initially stabilized the disease in both children. With advancing age more hypoglycemic events occurred with an increase in carbohydrate intake leading to obesity in both patients. In addition to Diazoxide Somatostatin analogues were successfully added in adulthood. A genetic analysis documented a new homozygote mutation in the HADH gene (HADH-variant c.796G>T). Acyl-Carnitine profile showed an increased plasma Butyryl-carnitine, consistent with a dysfunction of the HADH enzyme. 68Gallium-DOTA-exendin showed an increased uptake in the whole pancreas in both patients.

Conclusion: Clinical presentation, biochemical work-up and therapeutical response to Diazoxide and somatostatin analogues are consistent with previous reports of HADH-mutations. The overexpression of GLP-1 receptors in this context warrants further research.