Solovyev Maxim V, Yukina Marina Yu, Troshina Ekaterina A
Endocrinology Research Centre.
Probl Endokrinol (Mosk). 2020 Jun 10;65(6):474-480. doi: 10.14341/probl12266.
One of the reasons for the development of hypoglycemia is the synthesis of autoimmune antibodies to insulin or its receptor – insulin autoimmune syndrome (IAS). The largest number of cases of this syndrome is described in the Japanese population. The antibodies to insulin are most often polyclonal immunoglobulins. In monoclonal gammopathy of undetermined significance and multiple myeloma secreted pathological monoclonal immunoglobulin may have an affinity for human insulin, which induces the development of IAS. The prolonged persistence of episodes of hypoglycemia of unknown origin requires the exclusion of the monoclonal nature of secreted antibodies to insulin. Often the presence of pathological secretion for a long time is not recognized due to the absence of other manifestations of the disease. The manifestation of gammopathy is represented by a wide range of symptoms and syndromes requiring the collaboration of doctors of various specialties. This review summarizes the literature on IAS in patients with monoclonal gammopathy, whose disease debuted from episodes of spontaneous hypoglycemia. When hemoblastosis remission is achieved (when the secretion of the pathological protein is minimal or not determined), the glucose, insulin, and antibodies levels of insulin normalize, and when multiple myeloma recurs, episodes of hypoglycemia resume. The onset of the disease from the IAS can be considered as a new criterion for symptomatic multiple myeloma, dictating the need for the initiation of specific therapy.
低血糖发生的原因之一是机体合成了针对胰岛素或其受体的自身免疫抗体——胰岛素自身免疫综合征（IAS）。该综合征的病例数在日本人群中描述最多。胰岛素抗体最常见的是多克隆免疫球蛋白。在意义未明的单克隆丙种球蛋白病和多发性骨髓瘤中，分泌的病理性单克隆免疫球蛋白可能对人胰岛素具有亲和力，从而诱发IAS的发生。不明原因低血糖发作的长期持续存在需要排除分泌的胰岛素抗体的单克隆性质。由于缺乏疾病的其他表现，病理性分泌长期存在的情况往往未被识别。丙种球蛋白病的表现由广泛的症状和综合征组成，需要各专科医生的协作。本综述总结了关于单克隆丙种球蛋白病患者中IAS的文献，这些患者的疾病始于自发性低血糖发作。当血液系统疾病缓解时（病理性蛋白分泌极少或未检测到），血糖、胰岛素及胰岛素抗体水平恢复正常，而当多发性骨髓瘤复发时，低血糖发作又会再次出现。IAS导致的疾病发作可被视为有症状多发性骨髓瘤的一个新的标准，这表明需要启动特异性治疗。
