Izzo Valentina, Greco Carla, Corradini Diana, Infante Marco, Staltari Maria Teresa, Romano Maria, Bellia Alfonso, Lauro Davide, Uccioli Luigi
Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.
SAGE Open Med Case Rep. 2018 Dec 26;6:2050313X18819601. doi: 10.1177/2050313X18819601. eCollection 2018.
Insulin autoimmune syndrome is an unusual cause of spontaneous hypoglycaemia in non-Asian populations. In the majority of cases, this syndrome appears a few weeks after the administration of drugs containing a sulfhydryl group. A strong association between this syndrome and HLA-DR4 has been shown. Only seven cases have been described in non-Asian patients. We report the first case of insulin autoimmune syndrome in an Argentine woman taking alfa-lipoic acid. She developed hypoglycaemic symptoms approximately 1 month after starting therapy. Blood sampling collected during an episode of symptomatic hypoglycaemia showed low blood glucose level (2.39 mmol/L), high level of serum insulin (1971.55 pmol/L), inappropriately high level of C-peptide (2.36 nmol/L) and high levels of insulin antibodies (274.78 IU/mL). HLA-DNA typing identified DRB1*04:03. Due to the widespread use of alfa-lipoic acid for its antioxidant properties, clinicians should be aware that it may trigger an autoimmune hypoglycaemia in people with a genetic predisposition.
胰岛素自身免疫综合征是导致非亚洲人群自发性低血糖的一种罕见病因。在大多数病例中，该综合征在使用含巯基的药物几周后出现。已证实该综合征与HLA - DR4之间存在密切关联。非亚洲患者中仅报道过7例。我们报告了首例服用α -硫辛酸的阿根廷女性发生胰岛素自身免疫综合征的病例。她在开始治疗后约1个月出现低血糖症状。在一次有症状的低血糖发作期间采集的血样显示血糖水平低（2.39 mmol/L）、血清胰岛素水平高（1971.55 pmol/L）、C肽水平异常高（2.36 nmol/L）以及胰岛素抗体水平高（274.78 IU/mL）。HLA - DNA分型鉴定为DRB1*04:03。由于α -硫辛酸因其抗氧化特性而被广泛使用，临床医生应意识到它可能在有遗传易感性的人群中引发自身免疫性低血糖。
