Rare association of insulin autoimmune syndrome with ankylosing spondylitis

Raizada, Nishant; Rahaman, SH; Kandasamy, D; Jyotsna, Viveka P

doi:10.1530/edm-15-0090

Cited by 8 publications

(8 citation statements)

References 23 publications

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“…17 In cases of suspected IAS, there is a marked difference in the levels of serum total and free insulin after PEG precipitation. 3 In IAS, after PEG precipitation, levels of bound insulin are usually much higher, while those of free insulin are lower; the reverse is seen in healthy controls. 3 The molar ratio of insulin to C-peptide may be used as a marker for the diagnosis of IAS.…”

Section: Discussionmentioning

confidence: 98%

“…3 In IAS, after PEG precipitation, levels of bound insulin are usually much higher, while those of free insulin are lower; the reverse is seen in healthy controls. 3 The molar ratio of insulin to C-peptide may be used as a marker for the diagnosis of IAS. Insulin and C-peptide are secreted from the beta cells in equimolar concentrations, but insulin is cleared rapidly, with a half-life of 5 minutes, whereas C-peptide has a half-life of 30 minutes.…”

Section: Discussionmentioning

confidence: 98%

“…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.…”

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confidence: 99%

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Insulin Autoimmune Syndrome – A Case Series

Boro

Gupta

Singh

et al. 2020

European Endocrinology

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 98%

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Insulin Autoimmune Syndrome – A Case Series

Boro

Gupta

Singh

et al. 2020

European Endocrinology

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“…Literature is replete with association of IAAS with autoimmune disease[414] and haematological malignancies. ANA screening done in joint-related symptoms was positive for two patients.…”

Section: Discussionmentioning

confidence: 99%

Insulin autoantibody syndrome: Varying clinical presentations and response patterns of an underrecognized entity

Manjunath

Pavithran

Bhavani

et al. 2019

Indian J Endocr Metab

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Context:Insulin autoantibody syndrome (IAAS) is considered to be a rare cause of hyperinsulinaemic hypoglycaemia. Lack of familiarity with the varied clinical manifestations leads to underdiagnosis. Localization techniques aimed at insulin-secreting neoplasms and nesidioblastosis, which are expensive often are ordered when the correct diagnosis is not made.Aims:We describe the myriad of clinical manifestations associated with IAAS based on single centre experience.Settings and Design:Retrospective analysis of patients who got admitted with symptoms suggestive of hypoglycaemia and underwent mixed meal test and prolonged hypoglycaemic test from 2016 to 2019.Subjects and Methods:Retrospective data of 12 patients with IAAS who were diagnosed in the threeyear time period between 2016 and 2019 are included in this analysis. Clinical details, biochemical parameters and imaging modalities were analysed.Statistical Analysis:All analyses were performed with SPSS software (version 17).Results:Total of twelve patients 12 (5 male and 7 females) were identified as IAAS. Median age of presentation was 57 years. Median insulin levels and median C-peptide levels were 300 miu/ml and 18.5 ng/ml respectively. Only 3 (25%) patients had spontaneous resolution. Steroid induced remission occurred by 3 months in the remaining patients. Intermittent hyperglycaemia was seen in 9 (75%) patients. Implicatable drug use preceding the occurrence of the clinical symptoms was observed in five patients.Conclusion:IAAS is not uncommon in India. The diagnosis should be pursued in patients with hyperinsulinaemic hypoglycaemia especially when insulin levels are very high or when there is intermittent hyperglycaemia.

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“…First case was reported in 2013. [5][6][7] This can be the most important syndrome in the differential diagnosis of endogenous hyperinsulinemic hypoglycemia (EHH) so that early recognition can be done and unnecessary investigations can be avoided.…”

Section: Introductionmentioning

confidence: 99%

Hypoglycemia due to insulin autoimmune syndrome (Hirata’s disease): a rare cause of hypoglycaemia

Patel¹,

Kumar²,

Moradiya³

et al. 2021

Int J Adv Med

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Although the most common cause of recurrent hypoglycaemia is diabetes mellitus as patient is on antidiabetic medications which can be prevented by modification of antidiabetic doses, nutrition therapy and lifestyle modifications. Some endogenous hyperinsulinemic conditions like insulinoma, functional beta cell disorders and insulin autoimmune syndromes, hormonal deficiencies can cause serious and sometimes life threatening hypoglycaemia. So further laboratory evaluation like plasma/serum glucose levels, c-peptide levels, insulin levels, insulin antibodies and imaging studies are needed to evaluate unexplained hypoglycaemia. Here we report a case of insulin autoimmune syndrome in a 67 year old Indian male who had presented to us with multiple episodes of spontaneous hypoglycaemia. On further workup, the patient was found to have endogenous hyperinsulinemic hypoglycemia. As the patient’s abdominal imaging revealed no apparent cause of EHH, on further evaluation he came positive for insulin antibodies. Patient was diagnosed as IAS and he was given frequent small meals and complex carbohydrate diet and he had improved symptomatically. The incidence of IAS is most common in Japan and very few cases have been reported from India, so it should be kept in differential diagnosis of recurrent hypoglycaemia.

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Rare association of insulin autoimmune syndrome with ankylosing spondylitis

Cited by 8 publications

References 23 publications

Insulin Autoimmune Syndrome – A Case Series

Insulin Autoimmune Syndrome – A Case Series

Insulin autoantibody syndrome: Varying clinical presentations and response patterns of an underrecognized entity

Hypoglycemia due to insulin autoimmune syndrome (Hirata’s disease): a rare cause of hypoglycaemia

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