Methimazole-induced insulin autoimmune syndrome

Jain, Nidhi; Savani, Malvi; Agarwal, Manyoo; Kadaria, Dipen

doi:10.1177/2042018816658396

Cited by 15 publications

(14 citation statements)

References 17 publications

(16 reference statements)

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“…Additionally, glucocorticoids and immunosuppressants are prescribed to ameliorate immune dysregulation as well as avoid hypoglycemic attacks in IAS [8–12]. Other therapeutic options have also been shown to be successful in the management of IAS (e.g., acarbose for decreasing endogenous insulin secretion) [13]. In addition, plasmapheresis and rituximab can be used to eliminate insulin autoantibody titers in the circulation [1, 8, 12].…”

Section: Discussionmentioning

confidence: 99%

Insulin autoimmune syndrome induced by exogenous insulin injection: a four-case series

Song

Ren

2019

BMC Endocr Disord

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BackgroundInsulin autoimmune syndrome (IAS) is a rare cause of hypoglycemia and is characterized by the presence of insulin autoantibodies. Patients with IAS usually complain of hypoglycemia without any previous insulin received. Glucocorticoids and immunosuppressants are used to treat IAS.Case presentationWe report four patients with diabetes who were diagnosed with non-classical IAS and describe the treatment of these patients. Moreover, the differential diagnosis with hyperinsulinism is discussed.ConclusionHigh levels of insulin autoantibodies, as well as hyperinsulinemic hypoglycemia, are found in patients with diabetes mellitus and prior exogenous insulin exposure. This situation that we classified as non-classical IAS should be attached importance to.

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Section: Discussionmentioning

confidence: 99%

Insulin autoimmune syndrome induced by exogenous insulin injection: a four-case series

Song

Ren

2019

BMC Endocr Disord

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“…Glucocorticoids used in the treatment of thyrotoxicosis can cause hyperglycemia [ 69 ]. Methimazole-induced insulin autoimmune syndrome resulting in hypoglycemia has also been reported [ 70 ].…”

Section: Drugs Altering Metabolic and Thyroid Functionsmentioning

confidence: 99%

Thyroid Dysfunction and Dysmetabolic Syndrome: The Need for Enhanced Thyrovigilance Strategies

Kalra

Aggarwal²,

Khandelwal

2021

International Journal of Endocrinology

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Thyroid dysfunction (TD) is common in metabolic disorders such as diabetes mellitus (DM), cardiovascular disease (CVD), obesity, dyslipidemia, hyperuricemia, kidney and liver dysfunctions, and polycystic ovary syndrome (PCOS). Subclinical hypothyroidism (SHypo) worsens glycemic control in patients with DM, and these patients, especially those with Type-1DM, have higher prevalence of TD. Both TD and DM increase CVD risk. Even minor alteration in thyroid hormone (TH) levels can alter cardiovascular function. While hyperthyroidism increases systolic blood pressure and leads to high-output heart failure, hypothyroidism increases diastolic blood pressure and leads to low-output heart failure. Chronic subclinical hyperthyroidism (SHyper) and SHypo both increase the risk of hypertension, coronary artery disease (CAD) events, CAD deaths, and total deaths. SHyper alters cardiac morphology and function. SHypo causes dyslipidemia and endothelial dysfunction and increases the risk for weight gain and obesity. Overweight and obese patients often have hyperleptinemia, which increases the secretion of thyroid stimulating hormone (TSH) and induces TD. Dyslipidemia associated with TD can increase serum uric acid levels. Hyperuricemia promotes inflammation and may increase the risk for dyslipidemia, atherosclerosis, and CVD. TD increases the risk for developing chronic kidney disease. In nephrotic syndrome, proteinuria is associated with urinary loss of TH leading to TD. Some correlation between TD and severity of liver disease is also seen. TD and PCOS have common risk factors and pathophysiological abnormalities. Hypothyroidism must be excluded before diagnosing PCOS. Current guidelines do not strongly recommend thyroid screening in the presence of all metabolic disorders. However, pragmatic thyrovigilance is required. Clinicians must stay alert to signs and symptoms of TD, maintain high clinical suspicion, and investigate thoroughly. Drug-induced TD should be considered when TH levels do not match clinical findings or when patients are on medications that can alter thyroid function.

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“…Role of antithyroid drugs and lipoid acid in inducing IAAS is well reported in literature. [1213] Sulfhydryl group seems to be the responsible chemical moiety.…”

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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Methimazole-induced insulin autoimmune syndrome

Abstract: IAS is associated with methimazole use due to formation of autoantibodies to insulin after its interaction with Sulfhydryl (SH) group in methimazole. While IAS is a rare entity, it demands consideration in hypoglycemia in patients with autoimmune conditions.

Cited by 15 publications

References 17 publications

Insulin autoimmune syndrome induced by exogenous insulin injection: a four-case series

Insulin autoimmune syndrome induced by exogenous insulin injection: a four-case series

Thyroid Dysfunction and Dysmetabolic Syndrome: The Need for Enhanced Thyrovigilance Strategies

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

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