Endocrine Abstracts

The Insulin Autoimmune Syndrome (IAS) also called Hirata’s disease consists of hypoglycemia, high insulin concentration and presence of anti-insulin antibodies. IAS is the third leading cause of spontaneous hypoglycemia among Japanese population. The syndrome is exceptionally rare among Caucasians, with <50 cases described in literature.

In this report we showcase a 67 year-old female patient. She presented with paroxysmal sweating, daily fatigue and weakness with no triggering factors for these symptoms. Her blood glucose levels during those episodes were below 50 mg% measured by using a standard home glucometer device. Prolonged 72 h fast test showed extremely high insulin-glucose-ratio with moderate elevation of C-peptide levels. CT scans did not reveal any significant masses in the abdomen. The subsequent laboratory analysis showed high levels of anti-insulin antibodies with low insulin recovery by using polyethylene glycol precipitation method. After treatment with low glycemic index diet and prednisone the average glycemia has increased with the remission of the symptoms. There have been no incidents of hypoglycemia since the establishment of the treatment.

Our report indicates that at IAS should be considered in the differential diagnosis of spontaneous hypoglycemia in Caucasians. The treatment might lead to the remission of the symptoms.