Background: Leprechaunism, also known as Donohue syndrome, is due to a severe congenital insulin-resistance, with prenatal and neonatal growth retardation, typical dysmorphic features, glycaemic dysregulation with hyperinsulinism and hyperandrogenism.
Objective and hypotheses: These patients have a poor prognosis with death in the first year of life.
Method: We report the case of a newborn (35.4 weeks) with severe fetal growth restriction (weight: 1149 g; length: 38 cm; and cranial circumference: 28 cm), facial dysmorphic features with low implant ears, low implant hairs, hypertrichosis, hypertrophic external genitalia, and postnatal growth failure. This patient showed significant hyperglycaemic (327 mg/dl) alternated with hypoglycaemic values (10 mg/dl) also during infusion of significant dose of i.v. glucose (12 mg/kg per min), significant hyperinsulinism (1000 μU/dl) with elevated C peptide levels (43.41 ng/ml), persistent hypertension (113/74 mmHg). He has consanguineous parents (cousins).
Results: A treatment with diazoxide (5 mg/kg per day) was tried with limited efficacy. He was treated with ACE-inhibitor (Captopril) at the dose of 0.02 mg/kg per day with a low response. The Captopril dose was increased at 0.04 mg/kg per day with a regulation of the blood pressure (76/54 mmHg).
Conclusion: The genetic study of INS-R was performed. He presented a homozygote mutation in the insulin receptor (INS-R) gene. The mutation reported was c.3289C>T (CAG→TAG) p.Gln1097Stop (Q1097X).
20 - 22 Sep 2014
European Society for Paediatric Endocrinology