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Insulin Autoimmune Syndrome: A Case Report Highlighting Diagnostic Pitfalls
Hisatoshi Okumura1, Satoshi Inaba2, Atsushi Kawashima2
1Department of Emergency Medicine, Fukuchiyama City Hospital, Fukuchiyama, JPN.
Cureus
|August 9, 2024
Summary
Insulin autoimmune syndrome (IAS) causes hypoglycemia even with low C-peptide levels. This rare condition requires considering insulin autoantibodies for accurate diagnosis in adults.
Area of Science:
- Endocrinology
- Immunology
Background:
- Insulin autoimmune syndrome (IAS) is a rare disorder causing spontaneous hyperinsulinemic hypoglycemia.
- It is characterized by high titers of insulin autoantibodies without exogenous insulin use.
- C-peptide levels are typically used to differentiate hypoglycemia causes, with low levels suggesting external insulin administration.
Observation:
- A 47-year-old male nurse experienced an episode of hypoglycemia.
- His presentation showed hyperinsulinemic hypoglycemia with low C-peptide levels.
Findings:
- Despite low C-peptide levels, the patient was diagnosed with IAS.
- The diagnosis was confirmed by the presence of insulin autoantibodies.
Implications:
- This case highlights the importance of considering IAS in non-diabetic adults with hypoglycemia.
- It emphasizes that low C-peptide levels do not always rule out IAS.
- Accurate diagnosis of IAS relies on detecting insulin autoantibodies.
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