胰岛素自身免疫综合征伴Graves病1例并文献复习
| 作者: |
1,2陈楚晖,
1,2王维敏,
1,2金洁雯,
1,2倪文煜,
1,2顾天伟,
1,2毕艳,
1,2朱大龙
1 南京医科大学鼓楼临床医学院内分泌科，南京 210009 2 南京大学医学院附属鼓楼医院内分泌科，南京 210009 |
| 通讯: |
王维敏
Email: wwmlyg@189.cn |
| DOI: | 10.3978/j.issn.2095-6959.2019.04.037 |
| 基金: | 江苏省重点研发计划社会发展项目 (BE2016606)。 |
摘要
本文报道1例南京大学医学院附属鼓楼医院收治的胰岛素自身免疫综合征(insul in autoimmune syndrome，IAS)患者的诊治经过。患者女，53岁，间断服用甲巯咪唑4个月后出现反复低血糖性昏迷，行糖耐量试验发现空腹及餐后胰岛素显著升高，胰岛素和C肽浓度呈分离现象。胰岛素自身抗体(insulin autoantibody，IAA)阳性，基因检测HLA-DRBI*0406阳性，诊断为IAS。予泼尼松治疗并逐渐减量后病情好转。IAS为导致严重低血糖的罕见疾病，临床需注意与其他低血糖病因相鉴别。
关键词：
低血糖；胰岛素自身免疫综合征；胰岛素自身抗体；Graves病
Methimazole-induced insulin autoimmune syndrome in Graves’ disease: A case report and review on literature
CorrespondingAuthor: WANG Weimin Email: wwmlyg@189.cn
DOI: 10.3978/j.issn.2095-6959.2019.04.037
Foundation: This work was supported by the Key Research and Development Program of Jiangsu Province, China (BE2016606).
Abstract
We presented the cases of a female with Graves’ disease who developed insulin autoimmune syndrome (IAS) after treatment with methimazole, in combination with a review of relevant literature. After treatment with methimazole for 4 months, this patient exhibited recurrent hypoglycemia coma. A 75-gramoral glucose tolerance test showed high fasting and postprandial insulin (>1 000 mIU/L) with disproportionately elevated C-peptide levels. This patient was found to have high titers of insulin autoantibodies and HLA-DRB1*0406. After treatment of metacortandracin, insulin autoantibodies turned negative within 10 months and there was no occurrence of hypoglycemia. IAS is a rare disease which results in recurrent hypoglycemia related to insulin autoantibodies and hyperinsulinemia, clinicians should carefully distinguish the causes of hypoglycemia.
Keywords：
hypoglycemia; insulin autoimmune syndrome; insulin autoantibody; Graves’ disease