Ann Pediatr Endocrinol Metab.  2013 Mar;18(1):32-35. 10.6065/apem.2013.18.1.32.

Insulin autoimmune syndrome induced by methimazole in a Korean girl with Graves' disease

• Lee SH
• Oh SH
• Chung WY

• KMID: 1429679
• DOI: http://doi.org/10.6065/apem.2013.18.1.32

Abstract

Hypoglycemia was detected in a 15-year-old girl due to loss of consciousness. She was diagnosed with Graves' disease and was being treated with methimazole for the past 4 months. A paradoxically increased insulin levels was found when she suffered from the hypoglycemic episode. An imaging study showed no mass lesion in the pancreas, and insulin antibodies were found in the serum. She was diagnosed with insulin autoimmune syndrome. Her HLA typing was performed, and it revealed HLA-DRB1 *04:06. The patient was treated with a corticosteroid for 2 months. After discontinuing the steroid, the insulin antibody titer decreased dramatically, and she did not have any episode of hypoglycemia since. This is the first report of insulin autoimmune syndrome in a Korean girl, and we have revealed the connection between HLA type and insulin autoimmune syndrome in Korea.

Keyword

Autoimmune syndrome; Graves' disease; Methimazole; Hypoglycemia; Adolescents

MeSH Terms

Adolescent
Graves Disease
Histocompatibility Testing
HLA-DRB1 Chains
Humans
Hypoglycemia
Insulin
Insulin Antibodies
Korea
Methimazole
Pancreas
Unconsciousness
HLA-DRB1 Chains
Insulin
Insulin Antibodies
Methimazole

Figure

• 

  Fig. 1 Blood glucose level in the patient. There were fluctuations of blood glucose levels from hypoglycemia (39 mg/dL) to hyperglycemia (up to 321 mg/dL). After taking oral hydrocortisone, the variability of blood glucose levels was decreased. During tapered hydrocortisone, there was no hypoglycemia.

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