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Response to sirolimus in a case of diffuse congenital hyperinsulinaemic hypoglycaemia due to homozygous KCNJ11 mutation
  1. Chirantap Markand Oza1,
  2. Vaman Khadilkar1,2,
  3. Sandeep Kadam3 and
  4. Anuradha Khadilkar1,2
  1. 1Growth and Endocrine Unit, Hirabai Cowasji Jehangir Medical Research Institute, Pune, Maharashtra, India
  2. 2Interdisciplinary School of Health Sciences, Savitribai Phule Pune University, Pune, Maharashtra, India
  3. 3Department of pediatrics and neonatology, King Edward Memorial Hospital, Pune, Maharashtra, India
  1. Correspondence to Dr Anuradha Khadilkar; anuradhavkhadilkar{at}


We present a case of a male neonate with refractory and persistent neonatal hypoglycaemia not responding to octreotide. On evaluation for hypoglycaemia, his cortisol was within the reference range while the serum insulin concentrations were high. Gallium-68 dotatate scan (GA-68 DOTA) showed diffuse pancreatic involvement. Genetic diagnosis of congenital hyperinsulinaemic hypoglycaemia due to KCNJ11 mutation was made. He was started on tablet sirolimus, after which the child was off all other medication and was euglycaemic. However, he developed bilateral pneumonia leading to acute respiratory distress syndrome with refractory shock. Our case highlights the response to sirolimus in a case of congenital hyperinsulinaemia (CHI) due to KCNJ11 mutation and severe adverse event thereafter.

  • Neonatal intensive care
  • Drugs: endocrine system
  • Unwanted effects / adverse reactions

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  • Contributors All the listed authors—CMO, VK, SK and AK—played a role in the clinical management, planning, execution, analysis, writing of the manuscript and that they all agree and accept responsibility for the contents of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.