Their absence does not rule out a CACNA1D channelopathy, and their presence cannot be predicted from the variant gating changes: (i) even variants (such as A749G or S652L) causing almost identical biophysical changes as PASNA variants (I750M) [3, 26, 64, 66, 72] were not associated with clinically overt endocrine symptoms; (ii) an identical variant (G403D) may cause severe disease but with different endocrine manifestations (primary aldosteronism in case no. 1, congenital hyperinsulinemic hypoglycemia in case no. 2); (iii) endocrine symptoms may resolve with age [18, 35]. Here, CACNA1D is linked to hyperinsulinemic hypoglycemia.