Insulin autoimmune syndrome: a rare cause of spontaneous hypoglycaemia in non-diabetic individuals

2020 ◽  
Vol 13 (12) ◽  
pp. e234448
Author(s):  
Shruthi Ravindra ◽  
Sahana Shetty
Keyword(s):  
Endoscopic Ultrasound ◽  
Insulin Autoantibodies ◽  
Exogenous Insulin ◽  
Insulin Autoimmune Syndrome ◽  
Autoimmune Syndrome ◽  
Pancreatic Tumour ◽  
Biochemical Evaluation ◽  
Antibody Levels ◽  
Hyperinsulinemic Hypoglycaemia

Insulin autoimmune syndrome (IAS) is a rare cause of hypoglycaemia, characterised by recurrent hypoglycaemic episodes secondary to insulin autoantibodies in individuals who are not exposed to exogenous insulin. We are reporting a case of IAS in a 64-year-old gentleman, who presented with predominant postprandial hypoglycaemic episodes. On biochemical evaluation, he was found to have hyperinsulinemic hypoglycaemia. Localisation studies with MRI abdomen and endoscopic ultrasound (EUS) were negative for pancreatic tumour. Tests sent for insulin antibody levels were elevated. The patient was treated with frequent meals, acarbose and glucocorticoids. Patient condition improved and did not experience hypoglycaemia on follow-up.

scholarly journals Insulin autoimmune syndrome induced by exogenous insulin injection: a four-case series

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Yimin Shen ◽  
Xiaoxiao Song ◽  
Yuezhong Ren
Keyword(s):  
Diabetes Mellitus ◽  
Case Series ◽  
Insulin Injection ◽  
Insulin Autoantibodies ◽  
Hyperinsulinemic Hypoglycemia ◽  
Exogenous Insulin ◽  
Case Presentation ◽  
Insulin Autoimmune Syndrome ◽  
Autoimmune Syndrome ◽  
Patients With Diabetes

Abstract Background Insulin autoimmune syndrome (IAS) is a rare cause of hypoglycemia and is characterized by the presence of insulin autoantibodies. Patients with IAS usually complain of hypoglycemia without any previous insulin received. Glucocorticoids and immunosuppressants are used to treat IAS. Case presentation We report four patients with diabetes who were diagnosed with non-classical IAS and describe the treatment of these patients. Moreover, the differential diagnosis with hyperinsulinism is discussed. Conclusion High levels of insulin autoantibodies, as well as hyperinsulinemic hypoglycemia, are found in patients with diabetes mellitus and prior exogenous insulin exposure. This situation that we classified as non-classical IAS should be attached importance to.

Insulin autoimmune syndrome in a methimazole-treated Graves' patient with polyclonal anti-insulin autoantibodies

1987 ◽  
Vol 3 ◽  
pp. S39-S39
Author(s):  
YAUJIUNNLEE ◽  
SHYIJANGSHIN ◽  
JIAKANNTORNG ◽  
WENJANGLIU ◽  
YUNGHSIUNGLAI ◽  
...  
Keyword(s):  
Insulin Autoantibodies ◽  
Insulin Autoimmune Syndrome ◽  
Autoimmune Syndrome

scholarly journals Assessment and Management of Anti-Insulin Autoantibodies in Varying Presentations of Insulin Autoimmune Syndrome

2018 ◽  
Vol 103 (10) ◽  
pp. 3845-3855 ◽  
Author(s):  
David Church ◽  
Luís Cardoso ◽  
Richard G Kay ◽  
Claire L Williams ◽  
Bernard Freudenthal ◽  
...  
Keyword(s):  
Insulin Autoantibodies ◽  
Insulin Autoimmune Syndrome ◽  
Autoimmune Syndrome

scholarly journals Insulin autoimmune syndrome: case report

2004 ◽  
Vol 122 (4) ◽  
pp. 178-180 ◽  
Author(s):  
Rodrigo Oliveira Moreira ◽  
Giovanna Aparecida Balarini Lima ◽  
Patrícia Carla Batista Peixoto ◽  
Maria Lucia Fleiuss Farias ◽  
Mario Vaisman
Keyword(s):  
Case Report ◽  
Pancreatic Tumor ◽  
Histopathological Examination ◽  
Severe Trauma ◽  
Insulin Antibodies ◽  
Insulin Levels ◽  
Insulin Autoimmune Syndrome ◽  
Autoimmune Syndrome ◽  
High Insulin ◽  
Biochemical Evaluation

CONTEXT: Insulin autoimmune syndrome (IAS, Hirata disease) is a rare cause of hypoglycemia in Western countries. It is characterized by hypoglycemic episodes, elevated insulin levels, and positive insulin antibodies. Our objective is to report a case of IAS identified in South America. CASE REPORT: A 56-year-old Caucasian male patient started presenting neuroglycopenic symptoms during hospitalization due to severe trauma. Biochemical evaluation confirmed hypoglycemia and abnormally high levels of insulin. Conventional imaging examinations were negative for pancreatic tumor. Insulin antibodies were above the normal range. Clinical remission of the episodes was not achieved with verapamil and steroids. Thus, a subtotal pancreatectomy was performed due to the lack of response to conservative treatment and because immunosuppressants were contraindicated due to bacteremia. Histopathological examination revealed diffuse hypertrophy of beta cells. The patient continues to have high insulin levels but is almost free of hypoglycemic episodes.

Severe hypoglycemia due to insulin autoimmune syndrome with insulin autoantibodies crossreactive to proinsulin

2001 ◽  
Vol 109 (04) ◽  
pp. 245-248 ◽  
Author(s):  
T. Lohmann ◽  
J. Kratzsch ◽  
K. Kellner ◽  
H. Witzigmann ◽  
J. Hauss ◽  
...  
Keyword(s):  
Severe Hypoglycemia ◽  
Insulin Autoantibodies ◽  
Insulin Autoimmune Syndrome ◽  
Autoimmune Syndrome

scholarly journals Analysis of the clinical characteristics of insulin autoimmune syndrome induced by exogenous insulin in diabetic patients

2021 ◽  
Vol 13 (1) ◽  
Author(s):  
Zuojun Li ◽  
Dan Yi ◽  
Lijuan Zheng ◽  
Shiran Li ◽  
Weijin Fang ◽  
...  
Keyword(s):  
Clinical Characteristics ◽  
Serum Insulin ◽  
Insulin Antibodies ◽  
Hypoglycemic Agents ◽  
Oral Glucose ◽  
Diabetic Patients ◽  
Exogenous Insulin ◽  
Oral Hypoglycemic Agents ◽  
Insulin Autoimmune Syndrome ◽  
Autoimmune Syndrome

Abstract Background The exact incidence, clinical features and uniform diagnostic criteria of exogenous insulin autoimmune syndrome (EIAS) are still unclear. The purpose of this study is to explore the clinical characteristics of EIAS and to provide a structural approach for clinical diagnosis, treatment and prevention. Methods The literature on EIAS in Chinese and English from 1970 to 2020 was collected for retrospective analysis. Results A total of 122 patients (33 males and 73 females) were included in the study with a median age of 67 years (range 14–86) and a median HbA1c of 7.7%. EIAS mainly occurred in type 2 diabetes mellitus patients using premixed insulin. Symptoms manifested were hypoglycemia in 86.54%, recurrent episodes of symptomatic hypoglycemia in 35.58%, nocturnal hypoglycemia along with daytime hyperglycemia in 21.15% and recurrent hypoglycemia after discontinued insulin in 64.43%. The onset of symptoms occurred at night, in the early morning or during fasting, ranging from a few days to 78 months after the administration of insulin. The mean blood glucose level during the hypoglycemic phase was 2.21 mmol/L (range 1–3.4), and the serum insulin levels were mainly ≥ 100 U/mL and were associated with low C-peptide levels (≤ 10 ng/ml). Insulin autoantibodies (IAAs) were positive in all EIAS patients. The 75-g extended oral glucose tolerance test (OGTT) mainly showed a diabetic curve. Pancreatic imaging was unremarkable. Withdrawal of insulin alone or combination of oral hypoglycemic agents or replacement of insulin formulations or with corticosteroid treatment eliminated hypoglycemia in a few days to 3 months. IAA turned negative in 6 months (median, range 1–12). No hypoglycemia episodes were observed at a median follow-up of 6 months (range 0.5–60). Conclusions EIAS is an autoimmune disease caused by insulin-binding antibodies in susceptible subjects. Insulin antibodies change glucose dynamics and could increase the incidence of hypoglycemic episodes. Detection of insulin antibodies is the diagnostic test. Changing therapeutic modalities reduced the incidence of hypoglycemic episodes.

Identification of Monoclonal Insulin Autoantibodies in Insulin Autoimmune Syndrome Associated with HLA-DRB1*0401

2000 ◽  
Vol 54 (1) ◽  
pp. 49-52 ◽  
Author(s):  
Masami Murakami ◽  
Masafumi Mizuide ◽  
Koji Kashima ◽  
Akira Kojima ◽  
Shin-ichi Tomioka ◽  
...  
Keyword(s):  
Insulin Autoantibodies ◽  
Insulin Autoimmune Syndrome ◽  
Autoimmune Syndrome
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