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Insulin autoimmune syndrome in an occidental woman: a case report and literature review.
- Source :
-
Archives of endocrinology and metabolism [Arch Endocrinol Metab] 2018 Oct; Vol. 62 (5), pp. 566-570. - Publication Year :
- 2018
-
Abstract
- Insulin autoimmune syndrome (IAS, Hirata's disease) is a rare hypoglycemic disorder characterized by spontaneous hypoglycemia associated with extremely high circulating insulin levels and positive anti-insulin antibody results. Thus far, most cases have been reported in Asian countries, notably Japan, with few cases reported in western countries. As a possible cause, it is associated with the use of drugs containing sulfhydryl radicals, such as captopril. This report refers to a 63-year-old female Brazilian patient with a history of postprandial hypoglycemia. After extensive investigation and exclusion of other causes, her hyperinsulinemic hypoglycemia was considered to have likely been induced by captopril. Most cases of IAS are self-limiting. However, dietary management, corticosteroids, plasmapheresis, and rituximab have already been used to treat patients with IAS. In our case, after discontinuation of captopril, an initial decrease in insulin autoantibody levels was observed followed by improvement in episodes of hypoglycemia. Although it is a rare disease, IAS should be considered in the differential diagnosis of endogenous hyperinsulinemic hypoglycemia. Patients with suspected IAS must be screened for autoimmunity-related drugs for insulin. Initial clinical suspicion of IAS can avoid unnecessary costs associated with imaging examinations and/or invasive surgical procedures.
- Subjects :
- Autoimmune Diseases ethnology
Autoimmune Diseases immunology
Blood Glucose analysis
Brazil
Female
Humans
Hypoglycemia ethnology
Insulin Antibodies immunology
Middle Aged
Syndrome
Antihypertensive Agents adverse effects
Autoimmune Diseases chemically induced
Captopril adverse effects
Hypoglycemia chemically induced
Hypoglycemia immunology
Insulin Antibodies drug effects
Subjects
Details
- Language :
- English
- ISSN :
- 2359-4292
- Volume :
- 62
- Issue :
- 5
- Database :
- MEDLINE
- Journal :
- Archives of endocrinology and metabolism
- Publication Type :
- Academic Journal
- Accession number :
- 30462811
- Full Text :
- https://doi.org/10.20945/2359-3997000000078