ALMS1 and hyperinsulinism: As a ciliary gene, ALMS1 pathogenic variants can lead to a wide range of clinical features involving the eye, ear, kidney, heart, liver, central nervous system, adipose tissue, gonads, and bones [7, 8], including cone-rod dystrophy, hearing loss, type 2 diabetes, insulin resistance with hyperinsulinemia, dilated cardiomyopathy, and progressive hepatic, renal failure and hyperinsulinemia as the main clinical features [3].