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Insulin autoimmune syndrome: Three case reports.

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Insulin autoimmune syndrome (IAS) can cause hypoglycemia. Early evaluation of insulin autoantibodies (IAA) and tailored glucocorticoid therapy are key to successful management and resolution of symptoms.

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Area of Science:

  • Endocrinology
  • Immunology

Background:

  • Insulin autoimmune syndrome (IAS) is a rare endocrine disorder.
  • Characterized by hypoglycemia, elevated insulin, and insulin autoantibodies (IAA) or insulin receptor antibodies (IRA).

Observation:

  • Three patients with IAS presented with recurrent hypoglycemia.
  • Two had type 2 diabetes mellitus, one had Graves' disease.
  • All patients tested positive for IAA, with elevated insulin levels disproportionate to C-peptide.

Findings:

  • Treatment involved insulin withdrawal, oral hypoglycemics (acarbose), and glucocorticoids (prednisone acetate) or antithyroid medication adjustment.
  • All patients achieved resolution of hypoglycemia and normalization of insulin and IAA levels within 3 months.

Implications:

  • High-insulin hypoglycemia warrants IAA testing when insulin levels don't match C-peptide.
  • Judicious use of glucocorticoids with appropriate timing is effective for IAS management.