title: An uncommon cause of hypoglycemia: insulin autoimmune syndrome.
abstract: BACKGROUND
  Insulin autoimmune syndrome (IAS) is a condition characterized by hypoglycemia associated with the presence of autoantibodies to insulin in patients who have not been injected with insulin.
  
  
  METHODS
  A female patient (aged 16 years and 3 months) presented with the complaint of being overweight. Physical examination revealed a body weight of 78.2 kg (+2.6 SD) and a height of 167 cm (+0.73 SD). While the patient's fasting blood glucose level was found to be 40 mg/dl, blood ketone was negative and the serum insulin level was determined as 379 mIU/ml. The patient was diagnosed with hyperinsulinemic hypoglycemia. Abdominal ultrasound, pancreas MRI and endoscopic ultrasound were normal. The daily blood glucose profile revealed postprandial hyperglycemia and reactive hypoglycemia in addition to fasting hypoglycemia. The results of anti-insulin antibody measurements were as high as 41.8% (normal range 0-7%). A 1,600-calorie diet containing 40% carbohydrate and divided into 6 meals a day was given to the patient. Simple sugars were excluded from the diet. Hypoglycemic episodes were not observed, but during 2 years of observation, serum levels of insulin and anti-insulin antibodies remained elevated.
  
  
  CONCLUSIONS
  In all hyperinsulinemic hypoglycemia cases, IAS should be considered in the differential diagnosis and insulin antibody measurements should be carried out.
authors: Pediatric Endocrinology Division, Dr. Sami Ulus Training and Research Children's Hospital, Ankara, Turkey.
authors: Senay
authors: S
authors: Savas-Erdeve
authors: Sebahat
authors: S
authors: Yılmaz Agladioglu
authors: Asan
authors: A
authors: Onder
authors: Havva Nur
authors: HN
authors: Peltek Kendirci
authors: Veysel Nijat
authors: VN
authors: Bas
authors: Elif
authors: E
authors: Sagsak
authors: Semra
authors: S
authors: Cetinkaya
authors: Zehra
authors: Z
authors: Aycan
mesh_terms: D000293:Adolescent; D001323:Autoantibodies / Q000032:analysis; D001327:Autoimmune Diseases / Q000097:blood / Q000150:complications* / Q000178:diet therapy; D001786:Blood Glucose / Q000378:metabolism; D002096:C-Peptide / Q000097:blood; D050528:Diet, Carbohydrate-Restricted; D003927:Diet, Diabetic; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000097:blood / Q000178:diet therapy / Q000209:etiology*; D007328:Insulin / Q000097:blood / Q000276:immunology*; D007330:Insulin Antibodies; D013577:Syndrome
chemical_list: D001323:Autoantibodies; D001786:Blood Glucose; D002096:C-Peptide; D007328:Insulin; D007330:Insulin Antibodies