一名因抗胰岛素抗体导致自身免疫性低血糖的白人患者的假性胰岛素瘤：游离C肽检测的价值
Pseudoinsulinoma in a white man with autoimmune hypoglycemia due to anti-insulin antibodies: value of the free C-Peptide assay.
作者信息
Arzamendi Audrey E, Rajamani Uthra, Jialal Ishwarlal
机构信息
From the Division of Endocrinology, Diabetes, & Metabolism and.
Laboratory for Atherosclerosis & Metabolic Research, Departments of Pathology and Internal Medicine, UC Davis Medical Center, Sacramento, CA; and.
出版信息
Am J Clin Pathol. 2014 Nov;142(5):689-93. doi: 10.1309/AJCPX56JQBJHUBGJ.
OBJECTIVES
Insulin autoimmune syndrome (IAS) is an extremely rare cause of hypoglycemia, particularly in non-Asian populations.
METHODS
In this report, we describe a white male patient with elevated total insulin (>100.0 μIU/mL), C-peptide, and proinsulin levels who was diagnosed with IAS due to anti-insulin antibodies. He also had a small IgG κ M-protein.
RESULTS
We show that anti-insulin antibodies and/or the monoclonal protein can significantly interfere with insulin and C-peptide immunoassays and propose polyethylene glycol precipitation to quantitate free C-peptide levels as a useful assay in differentiating IAS due to anti-insulin antibodies from insulinoma.
CONCLUSIONS
In patients presenting with hypoglycemia with excessively high insulin levels, consideration needs to be given to autoimmune hypoglycemia due to anti-insulin antibodies as a cause. Additionally, if total C-peptide levels are increased, free C-peptide needs to be quantitated following polyethylene glycol precipitation.
目的
胰岛素自身免疫综合征（IAS）是一种极为罕见的低血糖病因，在非亚洲人群中尤为如此。
方法
在本报告中，我们描述了一名白人男性患者，其总胰岛素水平（>100.0 μIU/mL）、C肽水平和胰岛素原水平升高，因抗胰岛素抗体而被诊断为IAS。他还存在低水平的IgG κ M蛋白。
结果
我们发现抗胰岛素抗体和/或单克隆蛋白可显著干扰胰岛素和C肽免疫测定，并提出聚乙二醇沉淀法来定量游离C肽水平，作为区分因抗胰岛素抗体导致的IAS与胰岛素瘤的有用检测方法。
结论
对于胰岛素水平过高且出现低血糖的患者，需要考虑抗胰岛素抗体引起的自身免疫性低血糖这一病因。此外，如果总C肽水平升高，则需要在聚乙二醇沉淀后对游离C肽进行定量。
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