胰岛素瘤伴有抗胰岛素抗体。

IF 0.7 Q4 ENDOCRINOLOGY & METABOLISM
Rikako Nakajima, Daisuke Sato, Ichirota Togashi, Hiroto Idesawa, Jun Ito, Kei Ito, Masanao Fujii, Hiroaki Yagyu
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引用次数: 0

摘要

摘要:一名 89 岁的女性患者有 6 年的病史,偶尔会出现意识障碍,吃点零食后症状就会缓解。在来我院就诊的三个月前,她曾因头部挫伤导致硬膜下血肿在当地一家医院住院治疗,在那里发现了之前未被发现的低血糖症。空腹血浆葡萄糖浓度为 37 mg/dL,血清胰岛素水平相对较高(34.9 µU/mL)。计算机断层扫描显示,她的胰腺尾部有一个 14 毫米的高强化肿瘤,于是她被转到我院接受进一步检查。长时间空腹测试显示,最后一餐后 8 小时,血浆葡萄糖浓度降至 43 毫克/分升(2.4 毫摩尔/升)。血清胰岛素、胰岛素原和 C 肽浓度分别为 21.1 µU/mL、16.9 pmol/L 和 2.72 ng/mL。随后静脉注射 1 毫克胰高血糖素后,血浆葡萄糖浓度升至 76 毫克/分升(4.2 毫摩尔/升)。此外,胰岛素与 C 肽的摩尔比为 0.14。这些数据表明存在胰岛素瘤。有趣的是,虽然她没有注射外源性胰岛素、服用α-硫辛酸或含巯基药物的病史,但血清中抗胰岛素抗体却升高(21.1 U/mL)。人类白细胞抗原(HLA)分型显示她具有 HLA-DRB1*0407 和 HLA-DRB1*1405 等位基因。使用双氮醇治疗可预防低血糖,但因体重增加和腿部水肿而停止。在确诊为胰岛素瘤近一年后,血清抗胰岛素抗体仍持续升高。我们介绍了一例罕见的胰岛素瘤同时伴有血清抗胰岛素抗体的病例:学习要点:胰岛素瘤同时伴有抗胰岛素抗体的病例十分罕见。胰岛素/胰肽摩尔比和血清胰岛素浓度有助于区分胰岛素瘤和自身免疫综合征。闪存葡萄糖监测系统适用于评估治疗效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Insulinoma presenting with anti-insulin antibodies.

Summary: An 89-year-old woman presented with a 6-year history of occasional episodes of impaired consciousness that were relieved by ingestion of a snack. Three months before presenting to our hospital, she had been hospitalized in a local hospital with subdural hematoma caused by a head contusion, where previously unrecognized hypoglycemia was discovered. Fasting plasma glucose concentration was 37 mg/dL, with a relatively high serum level of insulin (34.9 µU/mL). Computed tomography showed a 14 mm hyperenhancing tumor in the tail of the pancreas and she was referred to our hospital for further investigation. A prolonged fasting test revealed the plasma glucose concentration reduced to 43 mg/dL (2.4 mmol/L) at 8 h after the last meal. Serum insulin, proinsulin, and C-peptide concentrations were 21.1 µU/mL, 16.9 pmol/L, and 2.72 ng/mL, respectively. Subsequent intravenous administration of 1 mg of glucagon increased the plasma glucose concentration to 76 mg/dL (4.2 mmol/L). Moreover, the insulin-to-C-peptide molar ratio was 0.14. These data indicated the presence of insulinoma. Interestingly, serum anti-insulin antibodies were elevated (21.1 U/mL), although she had no history of taking exogenous insulin injection, alpha lipoic acid, or sulfhydryl group-containing agents. Human leukocyte antigen (HLA) typing revealed HLA-DRB1*0407 and HLA-DRB1*1405 alleles. Treatment with diazoxide prevented hypoglycemia, but was discontinued due to weight gain and leg edema. Elevated serum anti-insulin antibodies persisted almost 1 year after the diagnosis of insulinoma. We present a rare case of insulinoma concomitant with serum anti-insulin antibodies.

Learning points: Insulinoma presenting with concomitant anti-insulin antibodies appears rare. Insulin/C-peptide molar ratio and serum insulin concentration are useful for differentiating insulinoma and autoimmune syndrome. Flash glucose monitoring systems appear suitable for evaluating treatment outcomes.

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来源期刊
CiteScore
1.50
自引率
0.00%
发文量
142
审稿时长
9 weeks
期刊介绍: Endocrinology, Diabetes & Metabolism Case Reports publishes case reports on common and rare conditions in all areas of clinical endocrinology, diabetes and metabolism. Articles should include clear learning points which readers can use to inform medical education or clinical practice. The types of cases of interest to Endocrinology, Diabetes & Metabolism Case Reports include: -Insight into disease pathogenesis or mechanism of therapy - Novel diagnostic procedure - Novel treatment - Unique/unexpected symptoms or presentations of a disease - New disease or syndrome: presentations/diagnosis/management - Unusual effects of medical treatment - Error in diagnosis/pitfalls and caveats
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