Hypoketotic hypofattyacidaemic hypoinsulinaemic hypoglycaemia in a child with hemihypertrophy? A new syndrome.
BACKGROUND
Recurrent and persistent hypoketotic, hypofattyacidaemic hypoglycaemia in infancy and childhood is most frequently due to hyperinsulinism of infancy. This biochemical profile can also be due to non-islet cell tumour hypoglycaemia or circulating insulin-receptor autoantibodies. Hyperinsulinaemic hypoglycaemia is also seen in children with the Beckwith-Wiedemann syndrome, where it is usually transient.


RESULTS
We report a novel case of child with hemihypertrophy and severe persistent hypoketotic, hypofattyacidaemic hypoinsulinaemic hypoglycaemia. No 'big' pro-IGF2 forms or circulating insulin-receptor antibodies were found. Glucose and protein isotope turnover studies showed marked suppression of hepatic glucose production during fasting. There was no evidence for constitutive autophosphorylation of the insulin or IGF-1 receptor, and no evidence for up-regulation of IGF-1 receptor.


CONCLUSIONS
The precise pathophysiology of this novel case is still unclear.
Hussain
K
K
London Centre for Paediatric Endocrinology and Metabolism, Great Ormond Street Hospital for Children NHS Trust London and the Institute of Child Health, University College London, London, UK. K.Hussain@ich.ucl.ac.uk
Bodamer
O A F
OA
Cameron
F J
FJ
Camacho-Hubner
C
C
Soos
M A
MA
Jones
J
J
Krywawych
S
S
O'Rahilly
S
S
Aynsley-Green
A
A
D000015:Abnormalities, Multiple / Q000473:pathology*; D001323:Autoantibodies / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D002675:Child, Preschool; D005215:Fasting; D005227:Fatty Acids / Q000097:blood*; D005934:Glucagon / Q000008:administration & dosage; D005947:Glucose / Q000096:biosynthesis; D006801:Humans; D006984:Hypertrophy; D007003:Hypoglycemia / Q000097:blood* / Q000150:complications* / Q000178:diet therapy; D007275:Injections, Intravenous; D007328:Insulin / Q000097:blood*; D007330:Insulin Antibodies / Q000097:blood; D007335:Insulin-Like Growth Factor II; D007657:Ketone Bodies / Q000097:blood*; D008099:Liver / Q000378:metabolism; D008297:Male; D010766:Phosphorylation; D011498:Protein Precursors / Q000097:blood; D017526:Receptor, IGF Type 1 / Q000378:metabolism; D011972:Receptor, Insulin / Q000378:metabolism; D013577:Syndrome
D001323:Autoantibodies; D001786:Blood Glucose; D005227:Fatty Acids; D007328:Insulin; D007330:Insulin Antibodies; D007657:Ketone Bodies; D011498:Protein Precursors; C066038:proinsulin-like growth factor II; D007335:Insulin-Like Growth Factor II; D005934:Glucagon; D017526:Receptor, IGF Type 1; D011972:Receptor, Insulin; D005947:Glucose