Hypoglycemia due to Insulin Autoimmune Syndrome: A rare cause not to be forgotten

Alam, Sarah; Ozair, Maaz; Ahmad, Jamal

doi:10.1016/j.jecr.2016.05.003

Cited by 3 publications

(3 citation statements)

References 18 publications

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“…Endogenous hyper insulinemia hypoglycemia (EHH) is a condition resulting in the excessive low levels of glucose due to endogenous excess insulin production. The most common cause of EHH is insulinoma, though insulin autoimmune syndrome should also be taken into account as a rare cause of EHH (4). This study presents a case of insulin autoimmune syndrome resulting in high serum insulin levels, while the positivity of insulin autoantibodies during hypoglycemia and imaging methods were completely normal in terms of insulinoma.…”

Section: Discussionmentioning

confidence: 84%

Hypoglycemia Due to the Presence of Anti-insulin Antibodies: A Case Report

Alagüney¹,

Efe²,

Yorulmaz³

et al. 2019

Turk J Endocrinol Metab

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A 50-year-old male was referred to our clinic for hypoglycemic attacks. He denied using oral antidiabetic drugs, insulin, or herbal substances but admitted using proton pump inhibitors, pregabalin, and alpha lipoic acid. Venous blood glucose level was 44 mg/dL, C-peptide was 15.6 ng/mL, and insulin levels were >1.000 µIU/mL. His BMI was 21.4. No evidence of pancreatic or extra pancreatic insulinoma was found in imaging studies. No diagnostic results were obtained in the selective calcium receptor stimulation test. Anti-insulin antibody test was positive. The insulin autoimmune syndrome was diagnosed with low glucose levels. The symptoms were associated with very high serum insulin levels, and the patient was positive for the anti-insulin antibody. Alpha lipoic acid and proton pump inhibitors, which may cause insulin autoimmune syndrome, were discontinued and alpha glucosidase inhibitor and diet therapy were started. During follow-up, the patient did not report hypoglycemia. Insulin autoimmune hypoglycemia should be kept in mind in patients with very high levels of insulin and without evidence of insulinoma.

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Section: Discussionmentioning

confidence: 84%

Hypoglycemia Due to the Presence of Anti-insulin Antibodies: A Case Report

Alagüney¹,

Efe²,

Yorulmaz³

et al. 2019

Turk J Endocrinol Metab

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“…Continuous blood glucose monitoring system data confirmed that IAS alternates between postprandial hyperglycemia and postprandial hypoglycemia [ 46 ]. A few cases of insulin autoimmunity manifested as hypoglycemia after repeated diabetic ketoacidosis [ 47 ]. In addition, some patients with recurrent hypoglycemia and a long course of the disease may gain weight due to frequent eating [ 48 , 49 ].…”

Section: Resultsmentioning

confidence: 99%

Insulin Autoimmune Syndrome: A Systematic Review

Lin

Chen

Ning

2023

International Journal of Endocrinology

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Insulin autoimmune syndrome (IAS) is a rare endocrine disorder characterized by recurrent episodes of severe hypoglycemia, markedly elevated serum insulin, and positive insulin autoantibodies. In recent years, various countries have reported it one after another. It can be seen that we must pay attention to this disease. The diagnosis of IAS is challenging, requiring a careful workup aimed at excluding other causes of hyperinsulinemic hypoglycemia. High levels of insulin autoantibodies are found in patients, and C-peptide is not parallel to insulin, which could be diagnostic. IAS is a self-limiting disease with a good prognosis. Its treatment mainly includes symptomatic supportive treatment, such as adjusting the diet and using acarbose and other drugs to delay the absorption of glucose to prevent hypoglycemia. For patients with severe symptoms, available treatments may include drugs that reduce pancreatic insulin secretion (such as somatostatin and diazoxide), immunosuppressants (glucocorticoids, zaprin, and rituximab), and even plasma exchange to remove autoantibodies from the body. This review provides a comprehensive analysis of the epidemiology, pathogenesis, clinical manifestations, diagnosis and identification, and monitoring and treatment management of IAS.

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“…1 In India, which has a population of more than 1 billion, only 28 cases of IAS have been reported to date, to the best of our knowledge. [2][3][4][5][6][7][8][9][10] IAS is characterised by hyperinsulinaemic hypoglycaemia -elevated insulin autoantibody titres with no prior exposure to exogenous insulin. Most cases of IAS are self-limiting.…”

mentioning

confidence: 99%