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Licensed Unlicensed Requires Authentication Published by De Gruyter February 7, 2019

A rare case of congenital hyperinsulinism (CHI) due to dual genetic aetiology involving HNF4A and ABCC8

  • Louise Apperley , Dinesh Giri , Jayne A.L. Houghton , Sarah E. Flanagan , Mohammed Didi and Senthil Senniappan EMAIL logo



Congenital hyperinsulinism (CHI) occurs due to an unregulated insulin secretion from the pancreatic β-cells resulting in hypoglycaemia. Causative mutations in multiple genes have been reported. Phenotypic variability exists both within and between different genetic subgroups.

Case presentation

A male infant born at 35+6 weeks’ gestation with a birth weight of 4.3 kg [+3.6 standard deviation score (SDS)] had recurrent hypoglycaemic episodes from birth. Biochemical investigations confirmed a diagnosis of CHI. Diazoxide was started and the dose was progressively increased to maintain euglycaemia. His father was slim and had been diagnosed with type 2 diabetes in his 30s. Sequence analysis identified a heterozygous hepatocyte nuclear factor 4 alpha (HNF4A) mutation (p.Arg245Pro, c.734G>C) and compound heterozygous ABCC8 mutations (p.Gly92Ser, c.274G>A and p.Ala1185Val, c.3554C>T) in the patient. The p.Ala1185Val ABCC8 mutation was inherited from his unaffected mother and the p.Arg245Pro HNF4A and p.Gly92Ser ABCC8 mutations from his father. All three mutations were predicted to be pathogenic. Identification of the HNF4A mutation in the father established a diagnosis of maturity-onset diabetes of the young (MODY), which enabled medication change resulting in improved glycaemic control.


We report a rare patient with CHI due to dual genetic aetiology. Although he is currently responsive to the maximum dose of diazoxide, the long-term prognosis remains unclear.

Corresponding author: Dr. Senthil Senniappan, MD FRCPCH MSc (Diab) PhD, Consultant Paediatric Endocrinologist and Honorary Senior Lecturer, Department of Paediatric Endocrinology, Alder Hey Children’s NHS Foundation Trust, Liverpool L12 2AP, United Kingdom, Phone: +441512525281, Fax: +441512824606
aLouise Apperley and Dinesh Giri contributed equally to the manuscript.



  1. Author contributions: LA and DG collected the data, wrote and revised the draft. JH, SF and MD contributed to the revision of the draft. SS supervised the study and revised the final draft.

  2. Research funding: None declared.

  3. Employment or leadership: None declared.

  4. Honorarium: None declared.

  5. Competing interests: The funding organization(s) played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

  6. Statement of ethics: Full parental consent was obtained for publication.

  7. Conflicts of interest: None.

  8. ESPE/PES Members: Senthil Senniappan and Dinesh Giri.


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Received: 2018-09-05
Accepted: 2018-12-30
Published Online: 2019-02-07
Published in Print: 2019-03-26

©2019 Walter de Gruyter GmbH, Berlin/Boston

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