[Recurrent hypoglycemia in the insulin autoimmune syndrome].
A 72-year-old man with recurrent hypoglycaemia was suspected of having an insulinoma. But several diagnostic methods (computed tomography; mesenteric and coeliac angiography; sella imaging) did not reveal any tumour. 72-hour hunger test did not precipitate any spontaneous hypoglycaemia. A falling insulin-glucose ratio spoke against an insulin-producing tumour. Reactive symptomatic hypoglycaemia occurred 4.5 hours after an oral glucose test. Measurement of insulin concentration demonstrated a slow but pronounced increase (3500 microU) over an already raised initial value (816 microU/ml), typical of prediabetic metabolic regulation. Demonstration of insulin autoantibodies confirmed the diagnosis of an insulin autoimmune syndrome, which has a good prognosis. The patient became free of symptoms on a regimen of frequent small, carbohydrate-poor but fat and bulk-rich meals. Hypoglycaemia recurred when the diet was not observed.
Discher
T
T
Medizinische Klinik III, Universität Giessen, Frankfurt/Main.
Seipke
G
G
Friedmann
E
E
Velcovsky
H G
HG
Federlin
K
K
D000368:Aged; D001323:Autoantibodies / Q000097:blood*; D001327:Autoimmune Diseases / Q000150:complications* / Q000178:diet therapy; D001786:Blood Glucose / Q000032:analysis; D002445:Celiac Artery / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D005951:Glucose Tolerance Test; D006801:Humans; D007003:Hypoglycemia / Q000178:diet therapy / Q000209:etiology*; D007328:Insulin / Q000097:blood; D007330:Insulin Antibodies / Q000097:blood*; D007340:Insulinoma / Q000175:diagnosis; D008297:Male; D008638:Mesenteric Arteries / Q000000981:diagnostic imaging; D010190:Pancreatic Neoplasms / Q000175:diagnosis; D011379:Prognosis; D012008:Recurrence; D013577:Syndrome; D014057:Tomography, X-Ray Computed
D001323:Autoantibodies; D001786:Blood Glucose; D007328:Insulin; D007330:Insulin Antibodies
Rezidivierende Hypoglykämien bei Insulin-Autoimmunsyndrom.