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December 1984

Insulin Autoimmunity as a Cause of Hypoglycemia

Author Affiliations

From the Departments of Medicine, (Ms Ho and Drs Wang and Yueng) and Pathology (Dr Wu), Queen Mary Hospital, Hong Kong; and the Mason Clinic, Seattle (Drs Benson and Fredlund).

Arch Intern Med. 1984;144(12):2351-2354. doi:10.1001/archinte.1984.00350220067015

• "Autoimmune" hypoglycemia is a syndrome consisting of fasting hypoglycemia, hyperinsulinemia, and insulin-binding antibodies in a patient who has never been exposed to exogenous insulin. The stimulus for insulin-antibody formation and the mechanism of the hypoglycemia in this condition remain unknown. Three patients with this rare syndrome had severe hypoglycemia of limited duration. Two had received a drug containing a sulfhydryl group (methimazole and penicillamine) as treatment for an autoimmune disorder (Graves' disease and rheumatoid arthritis, respectively). A third patient who underwent surgery for a suspected insulinoma was found to have pancreatic beta cell hyperplasia. Drugs containing a sulfhydryl group may have a role in the etiology of the syndrome. Additionally, our findings suggest a relationship between circulating insulin antibodies and beta cell hyperplasia.

(Arch Intern Med 1984;144:2351-2354)

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