Congenital Hyperinsulinism in Infants with Turner Syndrome: Possible Association with Monosomy X and KDM6A
Christopher E Gibson1,2, Kara E Boodhansingh1, Changhong Li1
1Division of Endocrinology and Diabetes, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Insights
Congenital hyperinsulinism is more common in girls with Turner syndrome. This suggests that a gene on the X chromosome, KDM6A, may cause hyperinsulinism in Turner syndrome.
Area of Science:
- Endocrinology
- Genetics
- Pediatrics
Background:
- Previous reports suggested a link between congenital hyperinsulinism and Turner syndrome.
- This study investigates this potential association further.
Purpose of the Study:
- To examine clinical and molecular features of girls with both congenital hyperinsulinism and Turner syndrome.
- To determine the frequency of Turner syndrome in patients with hyperinsulinism.
Main Methods:
- Reviewed medical records of patients with both conditions.
- Studied insulin secretion in human and mouse islets.
- Investigated the role of KDM6A, an X chromosome gene.
Main Results:
- 12 girls with Turner syndrome and hyperinsulinism were identified.
- Turner syndrome was 48 times more frequent in hyperinsulinism patients than expected.
- Elevated cytosolic calcium and heightened insulin release were observed, linked to KDM6A inhibition.
Conclusions:
- Turner syndrome is more frequent in children with hyperinsulinism than previously thought.
- Haploinsufficiency of KDM6A may cause hyperinsulinism in Turner syndrome patients.
Background:
Previous case reports have suggested a possible association of congenital hyperinsulinism with Turner syndrome.
Objective:
We examined the clinical and molecular features in girls with both congenital hyperinsulinism and Turner syndrome seen at The Children's Hospital of Philadelphia (CHOP) between 1974 and 2017.
Methods:
Records of girls with hyperinsulinism and Turner syndrome were reviewed. Insulin secretion was studied in pancreatic islets and in mouse islets treated with an inhibitor of KDM6A, an X chromosome gene associated with hyperinsulinism in Kabuki syndrome.
Results:
Hyperinsulinism was diagnosed in 12 girls with Turner syndrome. Six were diazoxide-unresponsive; 3 had pancreatectomies. The incidence of Turner syndrome among CHOP patients with hyperinsulinism (10 of 1,050 from 1997 to 2017) was 48 times more frequent than expected. The only consistent chromosomal anomaly in these girls was the presence of a 45,X cell line. Studies of isolated islets from 1 case showed abnormal elevated cytosolic calcium and heightened sensitivity to amino acid-stimulated insulin release; similar alterations were demonstrated in mouse islets treated with a KDM6A inhibitor.
Conclusion:
These results demonstrate a higher than expected frequency of Turner syndrome among children with hyperinsulinism. Our data suggest that haploinsufficiency for KDM6A due to mosaic X chromosome monosomy may be responsible for hyperinsulinism in Turner syndrome.
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