J Korean Endocr Soc.  2006 Dec;21(6):536-541.

A Case of Autoimmune Hypoglycemia due to Insulin Antibody in Patient with End Stage Renal Disease

• Jung JY
• Kang ES
• Kim BS
• Chun SW
• Rhee Y
• Ahn CW
• Cha BS
• Lee EJ
• Lim SK
• Lee HC

Abstract

Fasting hypoglycemia results from several mechanisms. Autoimmune hypoglycemia is one of the rare causes of hypoglycemia, and characterized by hyperinsulinemia, fasting hypoglycemia and the presence of autoantibodies to insulin or insulin receptor. We report here on a 64-year-old male patient with autoimmune hypoglycemia with end stage renal disease. He had no history of diabetes or insulin use. He had experienced several severe hypoglycemic events. The serum C-peptide level was 7.48 ng/mL and the insulin concentration was 115.4 micro U/mL when the fasting plasma glucose level was 88 mg/dL. The insulin to glucose ratio was 5.42, which suggested the presence of insulinoma. Yet the radiologic studies, including magnetic resonance cholangiopancreatography, endoscopic ultrasonography and selective calcium stimulated venous sampling revealed no evidence of insulinoma. The insulin autoantibody level was 62 micro U/mL. Therefore, we could diagnosis the autoimmune hypoglycemia. The hypoglycemia was treated with prednisolone and the patient recovered from this. His insulin level decreased to 21.11 micro U/mL and the insulin autoantibody level decreased to 34 micro U/mL. Hypoglycemia in the hemodialysis patients is not uncommon. One should bear in mind autoimmune hypoglycemia as one of the causes of hypoglycemia in patients with no history of diabetes.

Keyword

Autoimmune hypoglycemia; End stage renal disease; Insulin antibody

MeSH Terms

Autoantibodies
Blood Glucose
C-Peptide
Calcium
Cholangiopancreatography, Magnetic Resonance
Diagnosis
Endosonography
Fasting
Glucose
Humans
Hyperinsulinism
Hypoglycemia*
Insulin*
Insulinoma
Kidney Failure, Chronic*
Male
Middle Aged
Prednisolone
Receptor, Insulin
Renal Dialysis
Autoantibodies
C-Peptide
Calcium
Glucose
Insulin
Prednisolone
Receptor, Insulin

Figure

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  Fig. 1 Pancreatobiliary magnetic resonance cholangiopancreatography & magnetic resonance image show no definite evidence of tumor.

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  Fig. 2 Endoscopic ultrasonogram shows no definite mass lesion presented in pancreas.

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  Figure 3 Celiac angiography shows normal findings.

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  Fig. 4 Insulin levels during selective arterial calcium stimulation venous sampling.

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