Lin MingXu, Chen YuHua, Ning Jie
Department of Endocrinology, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen 518110, Guangdong, China.
Guangdong Medical University, Zhanjiang 524000, Guangdong, China.
Int J Endocrinol. 2023 Feb 15;2023:1225676. doi: 10.1155/2023/1225676. eCollection 2023.
Insulin autoimmune syndrome (IAS) is a rare endocrine disorder characterized by recurrent episodes of severe hypoglycemia, markedly elevated serum insulin, and positive insulin autoantibodies. In recent years, various countries have reported it one after another. It can be seen that we must pay attention to this disease. The diagnosis of IAS is challenging, requiring a careful workup aimed at excluding other causes of hyperinsulinemic hypoglycemia. High levels of insulin autoantibodies are found in patients, and C-peptide is not parallel to insulin, which could be diagnostic. IAS is a self-limiting disease with a good prognosis. Its treatment mainly includes symptomatic supportive treatment, such as adjusting the diet and using acarbose and other drugs to delay the absorption of glucose to prevent hypoglycemia. For patients with severe symptoms, available treatments may include drugs that reduce pancreatic insulin secretion (such as somatostatin and diazoxide), immunosuppressants (glucocorticoids, zaprin, and rituximab), and even plasma exchange to remove autoantibodies from the body. This review provides a comprehensive analysis of the epidemiology, pathogenesis, clinical manifestations, diagnosis and identification, and monitoring and treatment management of IAS.
胰岛素自身免疫综合征（IAS）是一种罕见的内分泌疾病，其特征为反复发作的严重低血糖、血清胰岛素显著升高以及胰岛素自身抗体阳性。近年来，各国陆续有相关报道。可见我们必须重视这种疾病。IAS的诊断具有挑战性，需要进行仔细的检查以排除其他导致高胰岛素血症性低血糖的原因。患者体内发现高水平的胰岛素自身抗体，且C肽与胰岛素不平行，这可作为诊断依据。IAS是一种自限性疾病，预后良好。其治疗主要包括对症支持治疗，如调整饮食、使用阿卡波糖等药物延缓葡萄糖吸收以预防低血糖。对于症状严重的患者，可用的治疗方法可能包括减少胰腺胰岛素分泌的药物（如生长抑素和二氮嗪）、免疫抑制剂（糖皮质激素、扎普司特和利妥昔单抗），甚至进行血浆置换以清除体内的自身抗体。本综述对IAS的流行病学、发病机制、临床表现、诊断与鉴别、监测与治疗管理进行了全面分析。
