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Spontaneous hypoglycemia associated with autoimmunity specific to human insulin
Diabetes Care
|March 1, 1987
Summary
This study identifies autoimmune hypoglycemia in a patient with Graves' disease, caused by anti-human insulin autoantibodies. Accurate diagnosis required specialized antibody testing beyond typical insulinoma screening.
Area of Science:
- Endocrinology
- Immunology
- Metabolic Disorders
Background:
- Postprandial hypoglycemia can be challenging to diagnose, especially when typical causes like insulinoma are ruled out.
- Graves' disease, an autoimmune thyroid condition, can sometimes be associated with other autoimmune phenomena.
Observation:
- A 55-year-old woman with Graves' disease presented with recurrent postprandial hypoglycemia unresponsive to standard investigations.
- Elevated fasting total insulin and proinsulin levels, with delayed insulin clearance, were noted, but free insulin levels were normal.
Findings:
- The patient demonstrated insulin-binding antibodies specific to human insulin, identified via ELISA and radioimmunoassay.
- Analysis revealed a monoclonal human insulin autoantibody with lambda-light chain restriction and specific T-lymphocyte responses to human insulin, indicating autoimmune hypoglycemia.
Implications:
- This case highlights the importance of considering autoimmune hypoglycemia in patients with unexplained hypoglycemia and elevated insulin levels.
- Sensitive antibody assays targeting human insulin are crucial for diagnosing this rare condition, differentiating it from insulinoma.
- Understanding the interplay between autoimmune diseases like Graves' and other autoimmune manifestations is vital for comprehensive patient care.