Hrudka Jan, Sticová Eva, Krbcová Magdaléna, Schwarzmannová Klára
Department of Pathology, 3rd Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, 100 34 Prague, Czech Republic.
Department of Internal Medicine, 3rd Faculty of Medicine, Charles University, University Hospital Kralovske Vinohrady, 100 34 Prague, Czech Republic.
Diagnostics (Basel). 2023 Jul 20;13(14):2415. doi: 10.3390/diagnostics13142415.
Localized insulin-derived amyloidosis (LIDA) is a rare local complication of subcutaneous insulin application occurring in patients with diabetes type 1 and 2. A 45-year-old woman with an 11-year history of insulin-dependent diabetes mellitus type 1 underwent a mini-abdominoplasty and excision of a long-standing palpable mass in left hypogastric subcutaneous tissue in the area of long-term insulin application. Histopathological examination revealed insulin amyloidosis as a substrate of the mass lesion. Several months after surgery, there was a transient improvement in previously poor diabetes compensation. In addition to local allergic reactions, abscess formation, scarring, lipoatrophy/dystrophy, and lipohypertrophy, LIDA broadens the differential diagnostic spectrum of local insulin injection complications. LIDA has been described as a cause of poor glycemia compensation, probably due to the conversion of soluble insulin into insoluble amyloid fibrils, which prevents insulin from circulating in the blood and regulating glucose blood concentration. Improvement in diabetes compensation has been described in several reports, including our case. LIDA is a rare local complication of subcutaneous insulin application; accurate diagnosis and treatment have clinical consequences. Immunohistochemical or immunofluorescence distinction from other amyloid types is highly recommended.
局限性胰岛素源性淀粉样变（LIDA）是1型和2型糖尿病患者皮下注射胰岛素后罕见的局部并发症。一名患有11年1型胰岛素依赖型糖尿病病史的45岁女性接受了小腹部整形手术，并切除了长期胰岛素注射部位左下腹皮下组织中一个长期可触及的肿块。组织病理学检查显示胰岛素淀粉样变是肿块病变的基础。手术后几个月，之前较差的糖尿病控制情况有了短暂改善。除了局部过敏反应、脓肿形成、瘢痕形成、脂肪萎缩/营养不良和脂肪增生外，LIDA还拓宽了局部胰岛素注射并发症的鉴别诊断范围。LIDA被认为是血糖控制不佳的一个原因，可能是由于可溶性胰岛素转化为不溶性淀粉样纤维，这阻止了胰岛素在血液中循环并调节血糖浓度。包括我们的病例在内，多篇报道中都描述了糖尿病控制情况的改善。LIDA是皮下注射胰岛素罕见的局部并发症；准确的诊断和治疗具有临床意义。强烈建议通过免疫组织化学或免疫荧光法与其他类型淀粉样变进行鉴别。
