Drug-induced insulin autoimmune syndrome

Uchigata, Yasuko; Hirata, Yoshihiro; Iwamoto, Yasuhiko

doi:10.1016/j.diabres.2008.10.015

Cited by 87 publications

(89 citation statements)

References 9 publications

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“…2 First described by Hirata et al in 1970, 3 it is the third leading cause of spontaneous hypoglycemia in Japan following insulinoma and extrapancreatic neoplasms. 4 Over 380 cases have been reported in the medical literature since, 5 with the majority (90 %) depicted in the Japanese population. Regardless, IAS is also recognized in other countries, including Europe and the United States (US).…”

Section: Discussionmentioning

confidence: 99%

“…8 Methimazole is the most commonly implicated drug; others include carbimazole, glutathione, tiopronin, tolbutamide, gold thioglucose, interferon-α, captopril, diltiazem, hydralazine, procainamide, isoniazid, D-penicillamine, imipenem and penicillin G. 6,7,9 Alpha-lipoic acid, a popular health supplement for the treatment of diabetic neuropathy and obesity, has been linked to IAS in recent years. 5 Although the precise mechanism for hypoglycemia in IAS is unknown, the most widely accepted hypothesis is a mismatch between blood glucose and free insulin concentration, secondary to the binding and release of secreted insulin by autoantibodies. 7 Following a meal or oral glucose load, glucose concentration in the bloodstream rises, providing a stimulus for insulin secretion.…”

Section: Discussionmentioning

confidence: 99%

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Recurrent Hypoglycemia from Insulin Autoimmune Syndrome

2013

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Insulin autoimmune syndrome (IAS) is an uncommon cause of hyperinsulinemic hypoglycemia characterized by autoantibodies to endogenous insulin in individuals without previous exposure to exogenous insulin. IAS is the third leading cause of spontaneous hypoglycemia in Japan, and is increasingly being recognized worldwide in non-Asian populations. We report a case of IAS in a Caucasian woman with recurrent complaints of hypoglycemia, with laboratory findings of serum glucose 2.5 mmol/L (45 mg/dL), insulin 54,930 pmol/L (7,909 μIU/mL), connecting peptide (C-peptide) 4,104 pmol/L (12.4 ng/mL), and a corresponding insulin to C-peptide molar ratio of 13.4 during a spontaneous hypoglycemic event. Autoantibodies to insulin were markedly elevated at > 50 kU/L (> 50 U/mL). IAS should be considered in the differential diagnosis of hypoglycemia in non-diabetic individuals. Distinction from insulinoma is especially crucial to prevent unwarranted invasive procedures and surgical interventions in hypoglycemic patients.KEY WORDS: insulin autoimmune syndrome; hypoglycemia; insulin to C-peptide molar ratio.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Recurrent Hypoglycemia from Insulin Autoimmune Syndrome

2013

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“…IAS is common in Japan, and to date, approximately 380 cases have been reported (6). To the best of our knowledge, however, there are no reports of IAS in siblings, so our cases represent the first of siblings with IAS to be reported.…”

Section: Discussionmentioning

confidence: 86%

Two Sisters with Graves' Disease and Similar Clinical Features who Tested Positive for Anti-insulin Antibodies after Thiamazole Treatment

et al. 2016

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The older of a pair of sisters experienced hypoglycemia after the start of thiamazole (MMI) treatment. Based on a high insulin antibody level, she was diagnosed with insulin autoimmune syndrome (IAS). HLA-DNA typing identified DRB1*04:06. Although a 75-g oral glucose tolerance test (OGTT) showed biphasic insulin secretion, the secretion pattern became monophasic after discontinuation of the MMI. The younger sister was diagnosed with IAS after the start of MMI treatment. HLA-DNA typing identified DRB1*04:06. The 75-g OGTT showed biphasic insulin secretion, but it became monophasic after discontinuation of the MMI. According to the similar insulin secretion kinetics in the two sisters with IAS, we suspect that a genetic predisposition may be associated with the features of anti-insulin antibodies.

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“…Recently an increasing number of reports have referred to an association with IAS and α lipoic acid assumption. [2][3][4] Other secondary forms of IAS have been associated with autoimmune diseases as rheumatoid arthritis, systemic lupus erythematosus, polimiositis, vasculitis or with hematological diseases (multiple myeloma, monoclonal gammopathy of undetermined significance), liver disease and neoplasms. 1,5,6 It is very hard to estimate the number of patients affected by IAS out of Japan reported in the Literature.…”

Section: Discussionmentioning

confidence: 99%

“…At physical examination no abnormal alterations were present and her body mass index was normal (21 kg/m 2 On the basis of these data the diagnosis of insulin autoimmune syndrome was postulated.…”

Section: Case Reportmentioning

confidence: 99%

Primary insulin autoimmune syndrome in an Italian woman: a case report

et al. 2015

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Insulin autoimmune syndrome (IAS) is a rare syndrome characterized by fasting or postprandial hypoglycemia, high levels of anti-insulin antibodies and high concentration of total serum immunoreactive insulin. It is relatively known in Japan, rare in remaining Asia and it is extremely uncommon in Western countries, being characterized by a different race-related incidence and associated with HLADR4 alleles. Usually IAS is related to particular drugs, or to autoimmune, rheumatologic or hematological diseases, while it is very rare as a primary form. Here we described a case of an Italian woman affected by a primary form of Hirata syndrome.

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Drug-induced insulin autoimmune syndrome

Cited by 87 publications

References 9 publications

Recurrent Hypoglycemia from Insulin Autoimmune Syndrome

Recurrent Hypoglycemia from Insulin Autoimmune Syndrome

Two Sisters with Graves' Disease and Similar Clinical Features who Tested Positive for Anti-insulin Antibodies after Thiamazole Treatment

Primary insulin autoimmune syndrome in an Italian woman: a case report

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