[A case of recurrent hypoglycemic coma episodes associated with primary biliary cholangitis and literature review]

A case of primary biliary cholangitis (PBC) complicated with hypoglycemia admitted to the Department of Endocrinology, the Eighth Medical Center of the Chinese PLA General Hospital in March 2024. The patient was a 76-year-old man with a history of episodic consciousness disturbance for 8 months. The clinical presentation was characterized by central nervous system suppression consistent with hypoglycemia, with symptoms alleviating after glucose supplementation. At a plasma glucose level of 1.86 mmol/L, the insulin concentration was 79.8 pmol/L, and the C-peptide concentration was 1.49 nmol/L, suggestive of endogenous hyperinsulinemic hypoglycemia. Autoantibody testing showed positivity for anti-mitochondrial antibody M2, anti-centromere B protein antibody, and anti-soluble acidic nuclear protein 100 antibody. The diagnosis of PBC was confirmed by liver histopathology. After comprehensive exclusion of insulinoma, insulin autoimmune syndrome (IAS), and other endocrine and metabolic diseases, the hypoglycemia was attributed to hepatogenic hypoglycemia secondary to PBC. The hypoglycemic symptoms resolved after treatment with ursodeoxycholic acid and dietary modifications. A simultaneous literature review identified three relevant reports describing three cases of PBC-related hypoglycemia. The etiology was IAS in two cases, which resolved with glucocorticoid therapy, and autoimmune hepatitis in one case, which was treated with liver transplantation. While rare, PBC-associated hypoglycemia warrants clinical attention. The possibility of PBC should be considered in the differential diagnosis of unexplained hypoglycemia to improve diagnostic accuracy and treatment outcomes.