Dhaliwal Kanwarpal K, Bector Gaurav, Arora Saurabh, Singh Amanpreet, Kalra Sanjay
Medicine and Surgery, Dayanand Medical College and Hospital, Ludhiana, IND.
Endocrinology, Dayanand Medical College and Hospital, Ludhiana, IND.
Cureus. 2023 Jun 30;15(6):e41183. doi: 10.7759/cureus.41183. eCollection 2023 Jun.
Insulin autoimmune syndrome is a rare cause of recurrent hypoglycemic episodes that can mimic various other pathological problems leading to unnecessary diagnostic assessments and interventions. Here, we report a case of a healthy non-diabetic male in his 50s presenting with recurrent episodes of hypoglycemia with no prior exposure to exogenous insulin. During a 72-hour fasting test, his glucose levels reached 22 mg/dl within less than three hours. The lab tests showed insulin of 1000 μIU/mL and C-peptide of 4.99 ng/ml. On further evaluation, high titers of insulin autoantibodies (IAA) >100 U/ml (normal = <10 U/ml) were consistent with insulin autoimmune syndrome diagnosis. This case thus highlights the importance of including IAA titers in first-line investigations for hypoglycemia in a non-diabetic patient with strikingly high blood insulin levels.
胰岛素自身免疫综合征是反复发生低血糖发作的罕见原因，可模拟各种其他病理问题，导致不必要的诊断评估和干预。在此，我们报告一例50多岁健康非糖尿病男性病例，该患者反复出现低血糖发作，此前未接触过外源性胰岛素。在72小时禁食试验期间，他的血糖水平在不到三小时内降至22mg/dl。实验室检查显示胰岛素水平为1000μIU/mL，C肽水平为4.99ng/ml。进一步评估发现，胰岛素自身抗体（IAA）高滴度>100U/ml（正常为<10U/ml），这与胰岛素自身免疫综合征的诊断相符。因此，该病例凸显了在对血液胰岛素水平显著升高的非糖尿病低血糖患者进行一线调查时纳入IAA滴度检测的重要性。
