Insulin autoimmune syndrome

Abstract

Summary Insulin autoimmune syndrome (Hirata’s disease) is a disorder caused by development of autoantibodies to insulin and manifested by hypoglycaemic syndrome. The overwhelming majority of physicians do not include it in the differential diagnosis of hypoglycaemic states because of a misconception of an extremely low prevalence of this condition. This results in unnecessary drug therapy and unjustified surgical interventions in patients that otherwise would be successfully treated conservatively. This disease is strongly associated with certain alleles of the HLA gene. In most cases, this condition develops in predisposed individuals taking drugs containing sulfhydryl groups. Formation of autoantibodies to insulin may be observed in patients with other autoimmune disorders, as well as in those with multiple myeloma or monoclonal gammopathy of undetermined significance. This paper presents the first Russian case report of insulin autoimmune syndrome in an adult patient. Learning points: Insulin autoimmune syndrome, Hirata’s disease, anti-insulin antibodies, and hypoglycaemia.

Recurrent hypoglycaemia in a patient with thyrotoxicosis due to Insulin autoimmune syndrome

“…2023 January; 2(1):71-74 severe IAS. Somatostatin analogues, diazoxide, immunosuppressive agents (glucocorticoids, azathioprine and rituximab), alpha-glucosidase inhibitors all have been used (4,5,9). Plasmapheresis has been used in extreme situations for a rapid lowering of insulin autoantibodies (9).…”

Scientific opinion on the relationship between intake of alpha‐lipoic acid (thioctic acid) and the risk of insulin autoimmune syndrome

“…The incidence of IAS in Caucasians seems to be lower than in the Japanese population (Cappellani et al., 2020). However, the number of case reports regarding Caucasians has been increasing in recent years (Bresciani et al., 2011; Gullo et al., 2014; Michalopoulou Alevras et al., 2015; Lio et al., 2016; Ferreira et al., 2017; Bolayir et al., 2018; Cappellani et al., 2018; Veltroni et al., 2018; Alagüney et al., 2019; Moffa et al., 2019; Cambria et al., 2020; Okuroglu et al., 2020; Yukina et al., 2020). It is, however, difficult to estimate the actual incidence or conclude on a true increase in the disease incidence among Caucasians, because of a possible underestimation of the occurrence of the syndrome linked to a possible unawareness of the disease and its subsequent underdiagnosis and underreporting (Cappellani et al., 2020).…”

“…Glutamate at position 74 in all the alleles DRB1*04:03, DRB1*04:06 and DRB1*04:07 and serine at position 37 (unique to DRB1*04:06) have been proposed to be responsible for this increased predisposition for developing IAS (Yukina et al., 2020). DRB1*04:03 can be considered as the ancestral allele from which DRB1*04:06 and DRB1*04:07 developed independently by nucleotide substitution or by gene conversion (in case of DRB1*04:07) (Uchigata et al., 2000).…”

Hyperglycaemia converting to persistent hypoglycaemia

“…Insulin autoimmune syndrome usually spontaneously remits after 3–6 months once the offending trigger is removed 7–9 . Premixed insulin was stopped, small frequent meals with lower carbohydrate, lower glycaemic index content was consumed.…”