Exogenous Insulin Antibody Syndrome in a Pediatric Patient: Successful Treatment with Mycophenolate Mofetil.

IF 2.6 3区医学 Q3 ENDOCRINOLOGY & METABOLISM

Hormone Research in Paediatrics Pub Date : 2024-01-01 Epub Date: 2023-09-01 DOI:10.1159/000531767

Leslie Saba, Erica M Fatica, Amir B Orandi, Siobhan T Pittock, Ana L Creo

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Abstract

Introduction: Exogenous insulin antibody syndrome (EIAS) rarely occurs in type 1 diabetes and should be considered in those with blood glucose levels outside the target range requiring greater than 2 units/kg/day of insulin without obesity. We describe the novel treatment of this condition using mycophenolate mofetil monotherapy in a pediatric patient in the outpatient setting.

Case presentation: A 17-year-old Caucasian male with type 1 diabetes experienced an abrupt increase in insulin requirements from 1.7 to 3.3 units/kg/day. Total insulin level was 7 µIU/mL with free insulin of 4.8 µIU/mL (68% of the total insulin), suggesting the presence of insulin antibodies. Switching from insulin aspart to glulisine was unsuccessful as insulin requirements increased to 4.4 units/kg/day. Treatment with oral mycophenolate mofetil decreased insulin requirements to 1.4 units/kg/day after 7 months. Total and free insulin levels improved to 5.2 and 4.6 µIU/mL, respectively (free insulin was 88% of total insulin). No adverse effects were encountered.

Conclusion: Mycophenolate mofetil monotherapy is successful in safely treating EIAS in a pediatric patient.

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一名儿科患者的外源性胰岛素抗体综合征：成功治疗霉酚酸酯。

导言：外源性胰岛素抗体综合征（EIAS）很少发生在1型糖尿病患者身上，但对于那些血糖水平超出目标范围、需要胰岛素剂量超过2单位/公斤/天且无肥胖症的患者，则应考虑EIAS。我们描述了在门诊环境中使用霉酚酸酯单药治疗一名儿童患者的新方法：一名患有 1 型糖尿病的 17 岁白种男性患者的胰岛素需求量突然从 1.7 单位/公斤/天增加到 3.3 单位/公斤/天。胰岛素总水平为 7 µIU/mL，游离胰岛素为 4.8 µIU/mL（占胰岛素总水平的 68%），表明存在胰岛素抗体。由于胰岛素需求量增至 4.4 单位/千克/天，因此从天冬胰岛素转为谷力胰岛素并不成功。口服霉酚酸酯治疗 7 个月后，胰岛素需求量降至 1.4 单位/公斤/天。总胰岛素和游离胰岛素水平分别提高到 5.2 微升/毫升和 4.6 微升/毫升（游离胰岛素占总胰岛素的 88%）。没有出现任何不良反应：结论：霉酚酸酯单药疗法可成功安全地治疗一名儿童患者的胰岛素耐受不良反应。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hormone Research in Paediatrics ENDOCRINOLOGY & METABOLISM-PEDIATRICS

CiteScore

4.90

自引率

6.20%

发文量

审稿时长

4-8 weeks

期刊介绍： The mission of ''Hormone Research in Paediatrics'' is to improve the care of children with endocrine disorders by promoting basic and clinical knowledge. The journal facilitates the dissemination of information through original papers, mini reviews, clinical guidelines and papers on novel insights from clinical practice. Periodic editorials from outstanding paediatric endocrinologists address the main published novelties by critically reviewing the major strengths and weaknesses of the studies.