| Cbjective:Insulin autoimmune syndrome (IAS) is one of the important-causes of hypoglycemia in patients with non diabetes, but it is often misdiagnosed.Through the analysis of the clinical features of IAS in our hospital, and review the literature to improve the understanding of IAS.Methods:Retrospective collecte clinical data of 11 cases of IAS in our hospital during 2009-2015, Including gender and age, etiology, course, clinical manifestation, concomitant disease, insulin and C-peptide levels, insulin antibody,5 h 75 g oral glucose tolerance test (OGTT), treatment and prognosis), The clinical features of IAS were analyzed and a literature review.Results:1.Epidemiology:Male 6 cases, female 5 cases (Most literatures reported that there was no significant difference between male and female). Between the ages of 18-78 years old, average 51 years old, in the majority of>40 years old (72.8%)(Most of the literature reported that the incidence of IAS in the age of 17-77 years old, in the majority of>40 years).6 cases with Graves disease were treated with methimazole,1 cases of had penicillamine history,1 cases had a history of use of quinolones (reported mainly associated with Graves disease).2. Clinical manifestation:8 cases with low blood sugar, low blood sugar generally occurs in the night, the morning, a small number of pre meal hypoglycemia, postprandial hyperglycemia. Hypoglycemia in 6 cases of hunger, palpitations, cold sweats and other symptoms of sympathetic excitement, including 2 cases of repeated unconsciousness.2 cases showed no specific performance with high blood sugar, blood sugar in 20mmol/L fluctuations. 1 cases of repeated high and low blood sugar.3. Glucose metabolism related indexes3.1 Hypoglycemia:the lowest blood glucose fluctuation in 11 patients was l-2.6mmol/L, with an average of 1.9mmol/L.3.2 Insulin, C peptide level (nonOGTT) in hypoglycemia:insulin, C peptide levels were significantly elevated,7 cases of insulin mean>1000, C peptide mean 19.4.3.3 OGTT (2 patients with hypoglycemia and early termination)3.3.1 The mean blood glucose of 11 patients with OGTT at each time point was 4.2-9.2-12.1-13.4-7.5-5.2-3.5,insulin>729.4->891.4->1000->1000->1000->914.3->887.9,C peptide 8.36-12.69-16.17-19.18-12.95-10.12-7.16.3.3.2 Hypoglycemia occurred in 5 cases, including 2 cases occurred in 3h,3 cases occurred in 5h.6 cases achieved IGT,5 cases achieved the diagnostic criteria for diabetes mellitus (reported in the literature, most of the OGTT 2H IAS blood glucose reached IGT or diabetes diagnostic criteria.3.3.3 Most insulin and C-peptide values were higher than the normal value, the insulin peak at 2h, based on the value of dozens, of-hundreds of times, C peptide peak at 2h, the peak value based on the value of several times-tens of times (reported in the literature the insulin peak up to hundreds).3.4 When 11 cases of the lowest blood, glucose insulin/blood glucose, C peptide/blood glucose, insulin/C peptide mean is 317.43,2.45185.31 (literature reports the insulin/blood glucose for 0.7-4.5).4. IAA was positive in 11 cases of IAS.5. Pancreatic imaging (CT or MRI):In 11 cases,2 cases showed the full pancreas tail, and the remaining 9 cases were not abnormal.6. Treatment:11 cases of patients were treated with diet adjustment, discontinuation of thiol containing drugs or propylthiouracil,use of quinolone antibiotics to stop,thiol drugs to stop or propylthiouracil, discontinuation quinolones,including 2 cases with prednisone treatment,3 cases with alpha glycosidase inhibitor treatment.7. Course and outcome:The IAA of 2 cases were negative after 5 months in a review, Others without review.11 patients had no recurrence of hypoglycemia after remission. The course of 15d-1 years, the average 2.6 months (most of the literature reported that the course of the disease continues to 1-3 months).There is a self limited tendency, after the recovery is generally not relapse.Conclusions:1.The incidence of IAS is associated with the use of drugs containing thiol or quinolones, especially on the incidence of Graves and methimazole patients more easily.2. IAS almost all of the night or early morning hypoglycemia, some patients with preprandial hypoglycemia, postprandial hyperglycemia.3. When hypoglycemia,the value of insulin and C peptide was not increased properly, elevated insulin levels higher than Endogenous insulin like insulin tumor, but C peptide value was not significantly higher than that of insulin.4. Treatment on the diet adjustment, as well as the removal of predisposing factors can be alleviated. α-glucosidase inhibito has a certain effect, a few severe cases with glucocorticoid.5. The disease has self healing tendency and the prognosis is good.The course of disease is more than 1-3 months, after the recovery not arelapse. |
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