The Development of Central Pontine Myelinolysis in a Type 1 Diabetic Patient With Anti-Insulin Antibody and Similar Clinical Manifestations to Autoimmune Polyglandular Syndrome

Abstract

Central pontine myelinolysis is a demyelinating disorder, which is commonly associated with the rapid correction of hyponatremia. We repot an 84-year-old type 1 diabetic woman with high level of anti-insulin antibody, who developed central pontine myelinolysis, in spite of a careful correction of hyponatremia. We believe that high level of anti-insulin antibody and similar clinical manifestations to autoimmune polygrandular syndrome such as Candidiasis, hypothyroidism, type 1 diabetes and liver cirrhosis possibly due to autoimmune hepatitis may be associated with the development of central pontine myelinolysis.

Clinical, Endocrinological and Immunological Characteristics of Japanese Patients With Autoimmune Polyglandular Syndrome Type 3a

“…Both anti-GAD ab and anti-IA2 ab were negative in cases 24, 25 and 26 in Table 2; however, they were insulin-dependent and showed the positivity for anti-TPO ab and anti-TG ab, and they were included in patients with APS3a. Our previous reports [4,[7][8][9] and present study revealed a remarkable female predominance in APS3a, which agreed with previous reports [10,11]. Among patients with autoimmune diabetes, SPIDDM was the most common type of diabetes, and the positive rate of anti-GAD ab was higher than that of anti-IA2 ab.…”

“…Therefore, we defined the absence of diffuse goiter and/or primary hypothyroidism with positive anti-TPO ab or positive anti-TG ab as immunological Hashimoto thyroiditis. We also found an insulin-dependent female patient (urinary CPR < 0.3 μg/day) with positive anti-GAD antibody [9]. She has hypothyroidism treated by levothyroxine; however, both anti-TPO ab and anti-TG ab were negative.…”

“…We defined overt Hashimoto thyroiditis and immunological Hashimoto thyroiditis and subclinical hypothyroidism with positive anti-TPO ab or positive anti-TG ab as possible Hashimoto thyroiditis. Table 1 shows clinical, endocrinological and immunological characteristics of four our previously reported Japanese patients with ASP3a [4,[7][8][9]. All patients were female, and age ranged from 53 to 84 years old.…”

“…Although case reports about APS3a including ours were found by the search using Pubmed [4,[7][8][9], the information about clinical backgrounds of APS3a is very limited. Only one article reported clinical and genetic characteristics of adult APS3, and we found one more article which reported the incidence of APS3 in children with type 1 diabetes [10,11].…”