Insulin autoimmune syndrome: case report

Moreira, Rodrigo O.; Lima, Giovanna Aparecida Balarini; Peixoto, Patrícia Carla Batista; Farias, Maria Lúcia Fleiuss; Vaisman, Mário

doi:10.1590/s1516-31802004000400010

Cited by 16 publications

(12 citation statements)

References 2 publications

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“…Rituximab was shown to decrease insulin antibodies and the effect lasted for 3 years (72). There have been reports in the literature of pancreatic surgery as a treatment modality (73).…”

Section: Insulin Autoimmune Hypoglycemia Syndromementioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Pathogenesis and management of hypoglycemia

Kittah

Vella

2017

European Journal of Endocrinology

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Glucose is the main substrate utilized by the brain and as such multiple regulatory mechanisms exist to maintain glucose concentrations. When these mechanisms fail or are defective, hypoglycemia ensues. Due to these robust mechanisms, hypoglycemia is uncommon and usually occurs in the setting of the treatment of diabetes using glucose-lowering agents such as sulfonylureas or insulin. The symptoms of hypoglycemia are non-specific and as such it is important to confirm hypoglycemia by establishing the presence of Whipple's triad before embarking on an evaluation for hypoglycemia. When possible, evaluation of hypoglycemia should be carried out at the time of spontaneous occurrence of symptoms. If this is not possible then one would want to create the circumstances under which symptoms occur. In cases where symptoms occur in the post absorptive state, a 72-h fast should be performed. Likewise, if symptoms occur after a meal then a mixed meal study may be the test of choice. The causes of endogenous hyperinsulinemic hypoglycemia include insulinoma, post-bariatric hypoglycemia and noninsulinoma pancreatogenous hypoglycemia syndrome. Autoimmune hypoglycemia syndrome is clinically and biochemically similar to insulinoma but associated with high levels of insulin antibodies and plasma insulin. Other important causes of hypoglycemia include medications, non-islet cell tumors, hormonal deficiencies, critical illness and factitious hypoglycemia. We provide an overview of the pathogenesis and management of hypoglycemia in these situations.

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“…Rituximab was shown to decrease insulin antibodies and the effect lasted for 3 years (72). There have been reports in the literature of pancreatic surgery as a treatment modality (73).…”

Section: Insulin Autoimmune Hypoglycemia Syndromementioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Pathogenesis and management of hypoglycemia

Kittah

Vella

2017

European Journal of Endocrinology

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“…En países occidentales la incidencia es muy baja, con comunicaciones de casos aislados en Europa 6-8 y solamente tres casos en Sudamérica [9][10][11] . Se ha descrito una predisposición genética asociada al haplotipo HLA, siendo de mayor riesgo el haplotipo DRB1*0406, DQA1*0301 y DQB1*0302 12 , más frecuente en población asiática.…”

Section: Discussionunclassified

Síndrome de hipoglicemia autoinmune: Primeros casos en Chile

et al. 2015

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“…The clinical manifestation of hypoglycaemia varied [61]. Concomitant increase in serum proinsulin, insulin and C-peptide concentrations was interpreted as a prima facie evidence of "phantom" insulinoma [62]. Of interest too are two recent studies by Vezzosi et [64] who suggested that end-of-fast hypoglycaemia associated with serum proinsulin > 22 pmol/L best detect cases of insulinomas.…”

Section: Ias With Endogenous Antibodies Which Predominantly Bind Proimentioning

confidence: 99%

“…Both serum insulin and proinsulin were elevated with variable C-peptide concentrations dependent on immunoassays' cross-reactivities [3,31,62,65]. Elevated serum insulin concentrations associated with high proinsulin and C-peptide concentrations may be taken as prima facie evidence of an insulinoma if endogenous antibodies are not excluded a priori.…”

Section: Ias With Mixed Binding Endogenous Antibody(s) Against Insulimentioning

confidence: 99%

The insulin autoimmune syndrome (IAS) as a cause of hypoglycaemia: an update on the pathophysiology, biochemical investigations and diagnosis

Ismail¹

2016

Clinical Chemistry and Laboratory Medicine (CCLM)

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Abstract:Insulin autoimmune syndrome (IAS) is considered to be very rare in Caucasians. Understanding its pathophysiology is paramount in (a) appreciating its potential impact on analyses of pancreatic hormones and (b) explaining its highly variable clinical manifestations in non-diabetic, non-acutely ill patients with indeterminate hypoglycaemia. The underlying aetiology of IAS is the presence of variable affinity/avidity endogenous insulin antibodies in significant amounts. The two types of insulin antibodies namely antibodies which bind insulin and/ or proinsulin(s) and receptor antibodies (insulin mimetic) will be discussed. Their biochemical and immunological roles in causing hypoglycaemia will be highlighted. Clinical manifestations of IAS can vary from mild and transient to spontaneous, severe and protracted hypoglycaemia necessitating in extreme cases plasmapheresis for glycaemic control. Antibodies of IAS can interfere in pancreatic immunoassay tests causing erroneous and potentially misleading results. Thorough testing for endogenous insulin antibodies must be considered in the investigations of non-diabetic, non-acutely ill patients with indeterminate and/or unexplained hypoglycaemia.Keywords: endogenous insulin antibodies; Hirata's disease, insulin autoimmune hypoglycaemia; hypoglycaemia in non-diabetic; insulin autoimmune syndrome (IAS); interference in immunoassays of insulin, proinsulin and C-peptide; wrong immunoassay results .

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Insulin autoimmune syndrome: case report

Cited by 16 publications

References 2 publications

MANAGEMENT OF ENDOCRINE DISEASE: Pathogenesis and management of hypoglycemia

MANAGEMENT OF ENDOCRINE DISEASE: Pathogenesis and management of hypoglycemia

Síndrome de hipoglicemia autoinmune: Primeros casos en Chile

The insulin autoimmune syndrome (IAS) as a cause of hypoglycaemia: an update on the pathophysiology, biochemical investigations and diagnosis

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