PDF(Pubmed)
Abstract：
Localized insulin-derived amyloidosis (LIDA) is a rare local complication of subcutaneous insulin application occurring in patients with diabetes type 1 and 2. A 45-year-old woman with an 11-year history of insulin-dependent diabetes mellitus type 1 underwent a mini-abdominoplasty and excision of a long-standing palpable mass in left hypogastric subcutaneous tissue in the area of long-term insulin application. Histopathological examination revealed insulin amyloidosis as a substrate of the mass lesion. Several months after surgery, there was a transient improvement in previously poor diabetes compensation. In addition to local allergic reactions, abscess formation, scarring, lipoatrophy/dystrophy, and lipohypertrophy, LIDA broadens the differential diagnostic spectrum of local insulin injection complications. LIDA has been described as a cause of poor glycemia compensation, probably due to the conversion of soluble insulin into insoluble amyloid fibrils, which prevents insulin from circulating in the blood and regulating glucose blood concentration. Improvement in diabetes compensation has been described in several reports, including our case. LIDA is a rare local complication of subcutaneous insulin application; accurate diagnosis and treatment have clinical consequences. Immunohistochemical or immunofluorescence distinction from other amyloid types is highly recommended.
摘要：
局部胰岛素源性淀粉样变性（LIDA）是1型和2型糖尿病患者皮下胰岛素应用的罕见局部并发症。一名45岁的女性，有11年的胰岛素依赖型糖尿病病史，在长期胰岛素应用的区域中，接受了小型腹部成形术并切除了左侧腹下皮下组织中长期可触及的肿块。组织病理学检查显示胰岛素淀粉样变性是肿块病变的底物。手术后几个月，以前不良的糖尿病补偿有一过性改善.除了局部过敏反应，脓肿形成,疤痕,脂肪萎缩/营养不良，和脂肪肥大，LIDA拓宽了局部胰岛素注射并发症的鉴别诊断范围。LIDA已被描述为血糖补偿不良的原因，可能是由于可溶性胰岛素转化为不溶性淀粉样纤维，防止胰岛素在血液中循环和调节葡萄糖血液浓度。糖尿病补偿的改善已在一些报告中描述，包括我们的案子.LIDA是一种罕见的皮下胰岛素应用的局部并发症，准确的诊断和医治有临床后果。强烈建议将免疫组织化学或免疫荧光与其他淀粉样蛋白类型区分开。
