Department of General Surgery, The Third Xiangya Hospital, Central South University, Changsha, China.
Department of Pharmacy, The Third Xiangya Hospital, Central South University, Changsha, China.
J Clin Pharm Ther. 2021 Apr;46(2):470-475. doi: 10.1111/jcpt.13307. Epub 2020 Oct 29.
The number of case reports of insulin autoimmune syndrome (IAS) induced by methimazole (MMI) is increasing. The purpose of this study is to explore the clinical characteristics and provide a scientific reference for clinical diagnosis, treatment and prevention.
The literature on IAS cases and case series induced by MMI in Chinese and English was collected for retrospective analysis.
A total of 106 patients (males 33, females 73) were described in the Chinese and English literature. The median age of patients with IAS induced by MMI was 37 years (range 15-76) occurring during both regular and irregular MMI therapy or after resumption of medication. The onset of symptoms occurred at night or early morning, within days in some and up to 6 months in others; the symptoms were neuropathic in 65.31% and related to the autonomic nervous system in 33.67%. Blood glucose concentration in samples presumably taken during the hypoglycaemic phase was 1.7 mmol/L (median; range 0.03-4.7); insulin concentrations were elevated ≥100 mU/L (ref range) and associated with low C-peptide levels (<10 μg/L; ref range). Tests for IgG insulin autoantibodies (IAA) were positive in 104 patients (98.02%) and negative in two patients (1.98%). The 75-g oral glucose tolerance test (OGTT) showed impaired glucose tolerance and diabetic curves. Pancreatic imaging was unremarkable on computed tomography (CT), magnetic resonance imaging (MRI) and ultrasound. Withdrawal of MMI alone or with corticosteroid treatment reduced hypoglycaemic episodes within days to 3 months. IAA decreased and became negative in 3 months (median; range 1-12). Follow-up showed no recurrent hypoglycaemic episodes at 5 months (median; range 1-60).
Methimazole-induced IAS is a clinically rare autoimmune disease with hypoglycaemia that occurs during medication treatment that should be treated promptly.
甲巯咪唑（MMI）引起的胰岛素自身免疫综合征（IAS）的病例报告数量正在增加。本研究的目的是探讨其临床特征，为临床诊断、治疗和预防提供科学参考。
收集了中英文文献中关于 MMI 诱导的 IAS 病例和病例系列的文献进行回顾性分析。
中文和英文文献共描述了 106 例患者（男性 33 例，女性 73 例）。MMI 诱导的 IAS 患者的中位年龄为 37 岁（范围 15-76 岁），发生在规律和不规则 MMI 治疗期间或停药后恢复治疗时。症状发作时间为夜间或清晨，有些在数天内，有些则在 6 个月内；65.31%为神经病变，33.67%与自主神经系统相关。低血糖期采集的样本血糖浓度为 1.7mmol/L（中位数；范围 0.03-4.7）；胰岛素浓度升高≥100mU/L（参考范围），同时 C 肽水平降低（<10μg/L；参考范围）。104 例（98.02%）患者的 IgG 胰岛素自身抗体（IAA）检测阳性，2 例（1.98%）患者检测阴性。75g 口服葡萄糖耐量试验（OGTT）显示葡萄糖耐量受损和糖尿病曲线。CT、MRI 和超声检查胰腺无明显异常。单独停用 MMI 或联合皮质类固醇治疗可使低血糖发作在数天至 3 个月内减少。IAA 在 3 个月（中位数；范围 1-12）内减少并转为阴性。随访 5 个月（中位数；范围 1-60）时无复发性低血糖发作。
甲巯咪唑诱导的 IAS 是一种临床罕见的自身免疫性疾病，伴有药物治疗期间发生的低血糖，应及时治疗。
