A Case of Insulin Autoimmune Syndrome in a Patient with Partial Hypopituitarism

Obin Kwon, Eun Young Park, J. Yoon, K. J. Kim, Yong‐ho Lee, J. Hong, Eun Jig Lee, Sungkil Lim, Hyun Chul Lee, B. Cha
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Abstract

Insulin autoimmune syndrome is one of the rare causes of hypoglycemia, and characterized by hyperinsulinemic hypoglycemia associated with high titer of antibodies to endogenous insulin. We report a case of insulin autoimmune syndrome in a 57-year-old woman, presenting with mental changes due to hypoglycemia. She had no history of diabetes or insulin administration. The serum C-peptide level was 4.69 ng/mL and the insulin concentration was 229.55 μ U/mL, when fasting plasma glucose level was 32 mg/dL. The insulin-to-glucose ratio was 7.17, while there was no radiologic evidence of insulinoma. The insulin antibody level was over 100 μU/mL, resulting in the diagnosis of insulin autoimmune syndrome. Hormonal studies revealed partial hypopituitarism and a lack of glucagon-response to hypoglycemia. Hypoglycemia disappeared with replacement of prednisolone with levothyroxine therapy. Under secretion of growth hormone and of adrenocorticotropic hormone due to hypopituitarism were associated with insufficient counterregulation to hypoglycemia. One should keep in mind that insulin autoimmune syndrome or hypopituitarism is one cause of hypoglycemia in patients with no history of diabetes, and corticosteroid can be an effective treatment for
部分垂体功能低下患者的胰岛素自身免疫综合征1例
胰岛素自身免疫性综合征是低血糖的罕见病因之一,其特点是高胰岛素性低血糖与内源性胰岛素抗体高滴度相关。我们报告一例胰岛素自身免疫综合征在一个57岁的妇女,表现为精神变化,由于低血糖。患者无糖尿病史或胰岛素使用史。当空腹血糖为32 mg/dL时,血清c肽水平为4.69 ng/mL,胰岛素浓度为229.55 μ U/mL。胰岛素与葡萄糖比值为7.17,未见胰岛素瘤的影像学证据。胰岛素抗体水平大于100 μU/mL,诊断为胰岛素自身免疫性综合征。激素研究显示部分垂体功能低下和缺乏胰高血糖素对低血糖的反应。用左旋甲状腺素替代强的松龙治疗后,低血糖消失。垂体功能减退引起的生长激素和促肾上腺皮质激素分泌不足与对低血糖的反调节不足有关。人们应该记住,胰岛素自身免疫综合征或垂体功能低下是无糖尿病史患者低血糖的一个原因,皮质类固醇可以有效治疗
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