Autoimmune forms of hypoglycemia.
Autoimmune syndromes are a rare cause of hypoglycemia characterized by elevated levels of insulin in the presence of either anti-insulin antibodies (insulin autoimmune syndrome) or anti-insulin receptor antibodies (type B insulin resistance). Insulin autoimmune syndrome is the third leading cause of hypoglycemia in Japan, but has rarely been described in the non-Asian population.In the current study, we report the clinical and biochemical characteristics and clinical course of 2 white patients with insulin autoimmune syndrome, and present a literature review of non-Asian patients reported with insulin autoimmune syndrome. Also, we describe the clinical and biochemical characteristics of patients reported in the literature with type B insulin resistance who manifested hypoglycemia. We compare the clinical and laboratory features of insulin autoimmune syndrome and type B insulin resistance with each other and with other forms of hyperinsulinemic hypoglycemia.Autoimmune forms of hypoglycemia are uncommon. However, they should be considered in any patient with hypoglycemia in the setting of unsuppressed insulin levels associated with anti-insulin or anti-insulin receptor antibodies. Making the correct diagnosis may spare a hypoglycemic patient from an unnecessary pancreatic surgical procedure.
From Clinical Endocrinology Branch (BCL, AYC, EKC, PG), National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland, United States; and University of Cambridge Metabolic Research Laboratories (MAS, RKS), Institute of Metabolic Science, Addenbrooke's Hospital, Cambridge, United Kingdom.
Beatrice C
BC
Lupsa
Angeline Y
AY
Chong
Elaine K
EK
Cochran
Maria A
MA
Soos
Robert K
RK
Semple
Phillip
P
Gorden
D000368:Aged; D001323:Autoantibodies / Q000097:blood*; D001327:Autoimmune Diseases / Q000188:drug therapy / Q000276:immunology* / Q000503:physiopathology; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007003:Hypoglycemia / Q000188:drug therapy / Q000276:immunology* / Q000503:physiopathology; D007328:Insulin / Q000097:blood / Q000276:immunology*; D007333:Insulin Resistance / Q000276:immunology*; D008297:Male; D011239:Prednisolone / Q000627:therapeutic use; D011972:Receptor, Insulin / Q000276:immunology*
D001323:Autoantibodies; D005938:Glucocorticoids; D007328:Insulin; D011239:Prednisolone; D011972:Receptor, Insulin