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Yao D, Jiang J, Zhou Q, Feng C, Chu J, Chen Z, Yang J, Xia J, Chen Y. HLA Alleles Associate with Insulin Autoimmune Syndrome. Diabetes Metab Syndr Obes 2024; 17:3463-3475. [PMID: 39309309 PMCID: PMC11414634 DOI: 10.2147/dmso.s456466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2024] [Accepted: 08/27/2024] [Indexed: 09/25/2024] Open
Abstract
In recent years, there have been hundreds of reports on insulin autoimmune syndrome (IAS) globally; however, fewer than a hundred patients have undergone genetic testing. Our objective is to examine the background of IAS and the variations in drugs that trigger it among patients who have been genetically tested, aiming to deepen our understanding of this condition. HLA Analysis of 68 cases showed that DR4 is predominant, especially in individuals of East Asian descent, notably in DRB1 *0406. Methimazole was the primary drug associated with IAS in these populations, while in Caucasian individuals, the emphasis was on DRB1 *0403, with lipoic acid being the common inducer. The key factor determining disease risk is the combination of chromosomal allele variations, with HLA class II allele DR4 positive patients showing a strong association with DQA1 *0301/DQB1 *0302.
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Affiliation(s)
- Dan Yao
- Department of Endocrinology, Xiangshan Hospital of TCM Medical and Health Group, Xiangshan, Ningbo, People’s Republic of China
| | - Jiefeng Jiang
- Department of Endocrinology, Xiangshan Hospital of TCM Medical and Health Group, Xiangshan, Ningbo, People’s Republic of China
| | - Qianyun Zhou
- Department of Endocrinology, Xiangshan Hospital of TCM Medical and Health Group, Xiangshan, Ningbo, People’s Republic of China
| | - Caiyun Feng
- Department of Endocrinology, Xiangshan Hospital of TCM Medical and Health Group, Xiangshan, Ningbo, People’s Republic of China
| | - Jianping Chu
- Department of Endocrinology, Ningbo First Hospital, Ningbo, People’s Republic of China
| | - Zhiyan Chen
- Department of Endocrinology, Xiangshan Hospital of TCM Medical and Health Group, Xiangshan, Ningbo, People’s Republic of China
| | - Jie Yang
- Department of Endocrinology, Xiangshan Hospital of TCM Medical and Health Group, Xiangshan, Ningbo, People’s Republic of China
| | - Jinying Xia
- Department of Endocrinology, Ningbo No. 2 Hospital, Ningbo, People’s Republic of China
| | - Yujia Chen
- Department of Endocrinology, Xiangshan Hospital of TCM Medical and Health Group, Xiangshan, Ningbo, People’s Republic of China
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Horinishi Y, Ohta R, Sano C. A Case of Insulin Autoimmune Syndrome Accompanied With Systemic Joint Pain: A Case Report. Cureus 2023; 15:e47140. [PMID: 38021632 PMCID: PMC10650969 DOI: 10.7759/cureus.47140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 12/01/2023] Open
Abstract
Insulin autoimmune syndrome (IAS) is a rare disorder characterised by autoantibodies against endogenous insulin that cause spontaneous hypoglycemic episodes. Here, we present the case of a 66-year-old male with polyarticular pain and dizziness that was initially suspected to be an insulinoma. However, further testing confirmed the presence of IAS. The patient's joint pain fluctuated but improved with the control of blood glucose levels. Although the direct relationship between IAS and joint pain is not well established, individuals with a single autoimmune disorder may develop concurrent autoimmune conditions. Joint pain is prevalent in patients with autoimmune diseases. Although hypoglycemia may cause muscle cramps due to stress responses, direct musculoskeletal damage is uncommon. This case underscores the importance of differential diagnosis, particularly in differentiating between pancreatic cancer and the benign proliferation of pancreatic B cells. Elevated levels of insulin autoantibodies confirm IAS, whereas pancreatic cancer may manifest various symptoms and elevated cancer antigens (CA) 19-9. General physicians should comprehensively investigate hypoglycemia cases, particularly those associated with pancreatic enlargement, and continually monitor for potential malignancies.
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Affiliation(s)
| | | | - Chiaki Sano
- Community Medicine Management, Shimane University Faculty of Medicine, Izumo, JPN
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Lin M, Chen Y, Ning J. Insulin Autoimmune Syndrome: A Systematic Review. Int J Endocrinol 2023; 2023:1225676. [PMID: 36844104 PMCID: PMC9946739 DOI: 10.1155/2023/1225676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 01/24/2023] [Accepted: 01/27/2023] [Indexed: 02/17/2023] Open
Abstract
Insulin autoimmune syndrome (IAS) is a rare endocrine disorder characterized by recurrent episodes of severe hypoglycemia, markedly elevated serum insulin, and positive insulin autoantibodies. In recent years, various countries have reported it one after another. It can be seen that we must pay attention to this disease. The diagnosis of IAS is challenging, requiring a careful workup aimed at excluding other causes of hyperinsulinemic hypoglycemia. High levels of insulin autoantibodies are found in patients, and C-peptide is not parallel to insulin, which could be diagnostic. IAS is a self-limiting disease with a good prognosis. Its treatment mainly includes symptomatic supportive treatment, such as adjusting the diet and using acarbose and other drugs to delay the absorption of glucose to prevent hypoglycemia. For patients with severe symptoms, available treatments may include drugs that reduce pancreatic insulin secretion (such as somatostatin and diazoxide), immunosuppressants (glucocorticoids, zaprin, and rituximab), and even plasma exchange to remove autoantibodies from the body. This review provides a comprehensive analysis of the epidemiology, pathogenesis, clinical manifestations, diagnosis and identification, and monitoring and treatment management of IAS.
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Affiliation(s)
- MingXu Lin
- Department of Endocrinology, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen 518110, Guangdong, China
| | - YuHua Chen
- Guangdong Medical University, Zhanjiang 524000, Guangdong, China
- Department of Endocrinology, Longgang District People's Hospital of Shenzhen, Shenzhen 518172, Guangdong, China
| | - Jie Ning
- Department of Endocrinology, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen 518110, Guangdong, China
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Han R, Jiang X. Methimazole-induced insulin autoimmune syndrome in Graves' disease with hypokalemia: A case report and literature review. Exp Ther Med 2020; 20:93. [PMID: 32973942 PMCID: PMC7506956 DOI: 10.3892/etm.2020.9221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 07/31/2020] [Indexed: 01/04/2023] Open
Abstract
The patient in the present case report, a 27-year-old man, was diagnosed with Graves' disease and hypokalemia. The patient was treated with methimazole and intermittent potassium supplementation. Following treatment, the patient was still suffering from fatigue, accompanied by palpitations, a hand tremor, fear of heat and sweating. Hypoglycemia was revealed by monitoring fingertip blood glucose levels. The laboratory investigations indicated that serum insulin levels were significantly elevated (>1,000 µIU/ml), the test for serum insulin autoantibody (IAA) was positive, and insulin autoimmune syndrome (IAS) was diagnosed. Following symptomatic treatment, the patients insulin levels decreased, and the hypoglycemia episode was gradually relieved. Hypoglycemia may be prone to missed diagnosis in patients with Graves' disease and hypokalemic periodic paralysis. Monitoring fingertip blood glucose level is a convenient and feasible method to detect hypoglycemia. Furthermore, serum insulin and IAA detection should be assessed to exclude or confirm IAS.
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Affiliation(s)
- Rongfeng Han
- Department of Endocrinology, Tianjin First Center Hospital, Tianjin 300192, P.R. China
| | - Xia Jiang
- Department of Endocrinology, Tianjin First Center Hospital, Tianjin 300192, P.R. China
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Cappellani D, Macchia E, Falorni A, Marchetti P. Insulin Autoimmune Syndrome (Hirata Disease): A Comprehensive Review Fifty Years After Its First Description. Diabetes Metab Syndr Obes 2020; 13:963-978. [PMID: 32308449 PMCID: PMC7136665 DOI: 10.2147/dmso.s219438] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 03/13/2020] [Indexed: 01/10/2023] Open
Abstract
Insulin autoimmune syndrome (IAS), also named Hirata's disease, is a rare condition characterized by hypoglycemic episodes due to the presence of high titers of insulin autoantibodies (IAA). IAS is a form of immune-mediated hypoglycemia, which develops when a triggering factor (ie, a medication or a viral infection) acts on an underlying predisposing genetic background. IAS pathogenesis involves the formation of insulin-IAA complexes that induce glycemic alterations with a double-phase mechanism: IAA prevent insulin to bind its receptor in the postprandial phase, possibly resulting in mild hyperglycemia; thereafter, insulin is released from the complexes irrespective of blood glucose concentrations, thus inducing hypoglycemia. The diagnosis of IAS is challenging, requiring a careful workup aimed at excluding other causes of hyperinsulinemic hypoglycemia. The gold standard for the definitive diagnosis is the finding of IAA in a blood sample. Because IAS is frequently a self-remitting disease, its management mostly consists of supportive measures, such as dietary modifications, aimed at preventing the development of hypoglycemia. Pharmacological therapies may occasionally be necessary for patients presenting with severe manifestations of IAS. Available therapies may include drugs that reduce pancreatic insulin secretion (somatostatin analogues and diazoxide, for instance) and immunosuppressive agents (glucocorticoids, azathioprine and rituximab). The purpose of this review is to provide a comprehensive analysis of the disease, by describing the burden of knowledge that has been obtained in the 50 years following its first description, took in 1970, and by highlighting the points that are still unclear in its pathogenesis and management.
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Affiliation(s)
- Daniele Cappellani
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa, Pisa, Italy
- Correspondence: Daniele Cappellani Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa, Ospedale Cisanello, via Paradisa 2, Pisa56124, ItalyTel +39 50 995001Fax +39 50 578772 Email
| | - Enrico Macchia
- Department of Clinical and Experimental Medicine, Unit of Endocrinology, University of Pisa, Pisa, Italy
| | - Alberto Falorni
- Department of Medicine, Section of Internal Medicine and Endocrine and Metabolic Sciences, University of Perugia, Perugia, Italy
| | - Piero Marchetti
- Department of Clinical and Experimental Medicine, Division of Metabolism and Cell Transplantation, University of Pisa, Pisa, Italy
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