title: Insulin autoimmune syndrome: case report.
abstract: BACKGROUND
  Insulin autoimmune syndrome (IAS, Hirata disease) is a rare cause of hypoglycemia in Western countries. It is characterized by hypoglycemic episodes, elevated insulin levels, and positive insulin antibodies. Our objective is to report a case of IAS identified in South America.
  
  
  METHODS
  A 56-year-old Caucasian male patient started presenting neuroglycopenic symptoms during hospitalization due to severe trauma. Biochemical evaluation confirmed hypoglycemia and abnormally high levels of insulin. Conventional imaging examinations were negative for pancreatic tumor. Insulin antibodies were above the normal range. Clinical remission of the episodes was not achieved with verapamil and steroids. Thus, a subtotal pancreatectomy was performed due to the lack of response to conservative treatment and because immunosuppressants were contraindicated due to bacteremia. Histopathological examination revealed diffuse hypertrophy of beta cells. The patient continues to have high insulin levels but is almost free of hypoglycemic episodes.
authors.affiliation: Endocrinology Service, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. rom_br@yahoo.com
authors.forename: Rodrigo Oliveira
authors.initials: RO
authors.lastname: Moreira
authors.forename: Giovanna Aparecida Balarini
authors.initials: GA
authors.lastname: Lima
authors.forename: Patrícia Carla Batista
authors.initials: PC
authors.lastname: Peixoto
authors.forename: Maria Lucia Fleiuss
authors.initials: ML
authors.lastname: Farias
authors.forename: Mario
authors.initials: M
authors.lastname: Vaisman
mesh_terms: D001327:Autoimmune Diseases / Q000097:blood / Q000150:complications*; D002096:C-Peptide / Q000097:blood; D006801:Humans; D006946:Hyperinsulinism / Q000097:blood / Q000209:etiology*; D007003:Hypoglycemia / Q000097:blood / Q000209:etiology*; D007328:Insulin / Q000097:blood; D007330:Insulin Antibodies / Q000097:blood; D008297:Male; D008875:Middle Aged; D013577:Syndrome
chemical_list: D002096:C-Peptide; D007328:Insulin; D007330:Insulin Antibodies