Hyperinsulin

ICD-10 code: E72.8, E71.3, E16.1

Familial hyperinsulinism (referred to as FHI in this GeneReview) is characterised by hypoglycemia that ranges from severe neonatal-onset, difficult-to-manage disease to childhood-onset disease with mild symptoms and difficult-to-diagnose hypoglycemia. Neonatal-onset disease manifests within hours to two days after birth. Childhood-onset disease manifests during the first months or years of life. In the newborn period, presenting symptoms may be nonspecific, including seizures, hypotonia, poor feeding, and apnea.

Insulin-resistance syndrome

Leprechaunism

ICD-10 code:E34.8

Leprechaunism is a congenital form of extreme insulin resistance (a group of syndromes that also includes Rabson-Mensenhall syndrome, type A insulin-resistance syndrome, and acquired type B insulin-resistance syndrome; see these terms) characterised by intrauterine and mainly postnatal severe growth retardation. Leprechaunism is associated with a characteristic dysmorphic facies (resembling that of the ‘leprechauns’ in Irish folk traditions), atrophic subcutaneous adipose tissue (lipoatrophy) and muscular hypotrophy. Signs of virilization are often observed in young girls. Biologically, episodes of hypo- and hyperglycemia are observed along with marked hyperinsulinemia due to an extreme resistance to insulin.

Berardinelli-Seip congen Lipodystrophy

ICD-10 code:E11, E13, E88.1

Berardinelli-Seip congenital lipodystrophy (BSCL) is characterised by the association of lipoatrophy, hypertriglyceridemia, hepatomegaly and acromegaloid features. BSCL belongs to the group of extreme insulin resistance syndromes, which also includes leprechaunism, Rabson-Mendenhall syndrome, acquired generalized lipodystrophy, and types A and B insulin resistance. BSCL is associated with insulin resistance resulting in clinically overt diabetes mellitus with onset during the second decade. Complications include hypertrophic cardiomyopathy, a fatty liver with hepatic dysfunction, muscular hypertrophy, a number of endocrine disturbances (accelerated growth in infancy, precocious puberty etc.) and bone cysts with spontaneous fractures.

Rare diabetes mellitus

Wolfram syndrome

ICD-10 code:E10.7

Wolfram syndrome (WS) also known as DIDMOAD, is a neurodegenerative disorder characterised by type I diabetes mellitus (DM), diabetes insipidus (DI), sensorineural deafness (D), bilateral optical atrophy (OA) and neurological signs. Onset of WS1 lies in the first decade. Patients present a progressive reduction of visual acuity and loss of color vision. Less frequent ocular abnormalities include abnormal papillary light reflexes, nystagmus, cataracts, pigmentary maculopathy, retinopathy (pigmentary or diabetic) and glaucoma. 50% of patients also develop DI and present some degree of deafness.

MODY

ICD-10 code:H48.0

MODY (maturity-onset diabetes of the young) is a rare, familial, clinically and genetically heterogeneous form of diabetes characterised by young age of onset (generally 10-45 years of age) with maintenance of endogenous insulin production, lack of pancreatic beta-cell autoimmunity, absence of obesity and insulin resistance and extra-pancreatic manifestations in some subtypes.

Neonatal diabetes

ICD-10 code:ICDP70.2

Neonatal diabetes mellitus presents as hyperglycemia, failure to thrive and, in some cases, dehydration and ketoacidosis which may be severe with coma, in a child within the first months of life. TNDM infants develop diabetes in the first few weeks of life but go into remission in a few months, with possible relapse to a permanent diabetes state usually around adolescence or as adults. The pancreatic dysfunction may be maintained throughout life, with relapse initiated at times of metabolic stress such as puberty or pregnancy.

Wolcott-Rallison syndrome

ICD-10 code:E10 D53.1

Wolcott-Rallison syndrome (WRS) is a very rare genetic disease, characterised by permanent neonatal diabetes mellitus (PNDM) with multiple epiphyseal dysplasia and other clinical manifestations, including recurrent episodes of acute liver failure. Diabetes occurs early, generally before six months of age, is permanent and insulin-dependent from the onset. Skeletal dysplasia generally manifests within the 1st or 2nd year of life, and is associated with short stature (dwarfism with short trunk). Deficient mineralization or dysplastic changes, affecting the long bones, pelvis and vertebrae, but usually not the skull, may be seen on radiography as early as diabetes onset.

Thiamine-responsive megaloblastic anemia

Thiamine-responsive megaloblastic anemia (TRMA) is characterised by a triad of megaloblastic anemia, non-type I diabetes mellitus, and sensorineural deafness. TRMA can present at any age between infancy and adolescence, although often not all key features are manifested at onset. TRMA is typically characterised by the triad of megaloblastic anemia responding to thiamine, sensorineural deafness, and non-type I diabetes mellitus. Clinical megaloblastic anemia manifestations may comprise hyporexia, lethargy, cephalalgia, pallor, diarrhea, and parasthesia in hands and feet. The variable phenotypic presentation of TRMA syndrome may cause a significant delay between the onset of symptoms and an accurate diagnosis.