Insulin autoimmune syndrome: case report.
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.
Moreira
Rodrigo Oliveira
RO
Endocrinology Service, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil. rom_br@yahoo.com
Lima
Giovanna Aparecida Balarini
GA
Peixoto
Patrícia Carla Batista
PC
Farias
Maria Lucia Fleiuss
ML
Vaisman
Mario
M
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
D002096:C-Peptide; D007328:Insulin; D007330:Insulin Antibodies