Hyperinsulinism-hyperammonemia syndrome caused by mutant glutamate dehydrogenase accompanied by novel enzyme kinetics

Hum Genet. 1999 Jun;104(6):476-9. doi: 10.1007/s004390050990.


Hyperinsulinism-hyperammonemia syndrome (HHS) is a recently identified genetic disorder characterized by hyperinsulinemic hypoglycemia with concomitant hyperammonemia. In patients with HHS, activating mutations in the glutamate dehydrogenase (GDH) gene have been identified. GDH is a key enzyme linking glutamate metabolism with the Krebs cycle and catalyzes the conversion of glutamate to alpha-ketoglutarate. The activity of GDH is controlled by allosteric inhibition by GTP and, so far, all the mutations of HHS patients have been located within the GTP-binding site. Characteristically, GDH from these individuals have therefore normal basal activity in conjunction with a loss of GTP inhibition. In this study, however, we have identified a novel variant GDH in a patient with a more severe form of HHS. The mutation is located outside the GTP-binding site and the patient's GDH shows consistently higher activity, even in the absence of allosteric effectors. These results further support the hypothesis that the activating mutation of GDH is the cause of HHS. The mechanism leading to the activation of GDH, however, is not always related to the loss of GTP inhibition as was originally suggested.

Publication types

  • Case Reports
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adenosine Diphosphate / pharmacology
  • Ammonia / blood*
  • Ammonia / metabolism
  • Base Sequence
  • Dose-Response Relationship, Drug
  • Genetic Markers
  • Genotype
  • Glutamate Dehydrogenase / genetics*
  • Guanosine Triphosphate / pharmacology
  • Humans
  • Hyperinsulinism / complications
  • Hyperinsulinism / enzymology*
  • Hyperinsulinism / genetics*
  • Kinetics
  • Male
  • Metabolism, Inborn Errors / genetics*
  • Molecular Sequence Data
  • Point Mutation
  • Polymorphism, Genetic
  • Syndrome


  • Genetic Markers
  • Adenosine Diphosphate
  • Ammonia
  • Guanosine Triphosphate
  • Glutamate Dehydrogenase