Spontaneous hypoglycemia and insulin autoantibodies in a patient with Graves' disease |
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| Authors: | B Y Cho H K Lee C S Koh H K Min |
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| Affiliation: | 1. Department of Neurological Science, Graduate School of Medicine, Nippon Medical School, Japan;2. Jinsenkai MI Clinic, Osaka, Japan;3. Department of Radiology, Institute of Biomedical Sciences, Tokushima University, Tokushima, Japan;4. Tokushima University Hospital, Tokushima University, Tokushima, Japan;2. Neuroeconomics and Social Neuroscience, Department of Economics, University of Zurich, Zurich, Switzerland;3. Li Ka Shing Knowledge Institute, St. Michael''s Hospital, University of Toronto, Toronto, Ontario, Canada |
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| Abstract: | A 31-year-old woman with Graves' disease developed fasting hypoglycemia after treatment for 3 weeks with methimazole. Although the patient had not received exogenous insulin, high titers of insulin autoantibodies were found in serum and large amounts of total and free insulin (1550 and 82 microU/ml, respectively) and C-peptide reactivity (CPR, 22 ng/ml) were detected in serum. After glucose loading, blood glucose and total insulin levels increased abnormally. The immunoglobulin class of the autoantibodies was IgG and the light chains were of the kappa type. The titers of insulin autoantibodies, elevated serum total and free insulin, and CPR levels decreased gradually, but insulin autoantibodies and elevated insulin levels were still present in the serum 8 months after the episode of hypoglycemia. These findings suggest that the patient's fasting hypoglycemia was due to excess free insulin released from antibody-bound insulin, and that methimazole might play a role in the initiation of production of insulin autoantibodies. |
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