[Insulin autoimmune syndrome : A rare, but important differential diagnosis of hypoglycemia]

Area of Science:

• Endocrinology
• Immunology
• Pharmacology

Background:

• Recurrent severe hypoglycemia can be a diagnostic challenge, necessitating the exclusion of common causes like insulinoma.
• Peripheral arterial obstructive disease (PAOD) management sometimes involves antiplatelet agents like clopidogrel.

Observation:

• A 69-year-old female presented with recurrent severe hypoglycemia.
• Despite normal to low blood glucose, serum insulin and insulin autoantibodies were elevated.
• Other causes, including insulinoma and paraneoplastic syndrome, were ruled out.

Findings:

• Insulin autoimmune syndrome (IAS) was diagnosed, strongly suspected to be induced by clopidogrel.
• Treatment with immunoadsorption led to a significant decrease in hypoglycemic episodes.

Implications:

• This case highlights clopidogrel as a potential trigger for drug-induced insulin autoimmune syndrome.
• Immunoadsorption offers an effective therapeutic option for managing this rare condition.
• Increased awareness of IAS is crucial for clinicians managing patients on specific medications.