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Endocrinol Nutr 2002;49:172-4 - DOI: 10.1016/S1575-0922(02)74450-1
Hipoglucemia por hiperinsulinismo endógeno autoinmune. A propósito de un caso y revisión de la bibliografía
Hypoglycemia due to endogenous hyperinsulinism. case report and review of the literature
J.A. Chena, D. Bernal, A. Zurutuza, M. Ferrer, C. Beltrán
Hospital General San Jorge. Centro de Salud Perpetuo Socorro. Huesca
Recibido 09 julio 2001, Aceptado 26 noviembre 2001

Hypoglycemia due to endogenous hyperinsulinism is mainly caused by pancreatic and extrapancreatic tumors. In the last few years, autoimmune causes have increased, the etiology of which recognizes the presence of specific antibodies against insulin, its receptor and even its beta cell. These are produced in the course of other autoimmune diseases and are related to them and/or to drugs used in their treatment (especially those containing the sulfhydryl group), which somehow alter the insulin molecule, conferring it with greater immunogenicity and simultaneously diminishing its biological activity.

The few reports published in the world literature, the fact that most cases have been described in oriental races and the strong correlation with certain HLA systems, suggest the existence of a predisposing genetic component.

In our case of hypoglycemia due to endogenous hyperinsulinism, tumoral origin was ruled out and high insulin and C peptide levels were found, together with a high titer of anti-insulin antibodies. These findings coincided with methimazole treatment for Graves' disease. Hypoglycemia spontaneously improved and disappeared on withdrawal of the drug. Although the hypoglycemia coincided with clinical findings of insulin autoimmune syndrome, first described by Hirata, there were certain features of special interest: firstly, the etiology and HLA system differed from those reported by Hirata; the free insulin titer was exceptionally high compared with that found in most cases and, finally, the coexistence of anti-GAD antibodies remained positive after normalization of clinical and biological parameters. This suggested the possible future development of diabetes mellitus with the same autoimmune etiology as the disease causing the case reported herein.

Palabras clave
Hipoglucemia autoinmune, Síndrome autoinmune por insulina, Grupo sulfidrilo, Insulina
Key words
Autoimmune hypoglycemia, Insulin autoimmune syndrome, Sulfhydryl group, Insulin
El Texto completo solo está disponible en PDF
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Correspondencia: Dr. J.A. Chena. Unidad de Endocrinología. Hospital General San Jorge. Avda. Martínez Velasco, 36. 22004 Huesca
Copyright © 2001. Sociedad Espa??ola de Endocrinolog??a y Nutrici??n