PDF(Pubmed)
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.
摘要：
胰岛素自身免疫综合征（IAS）是一种罕见的疾病，其特征是针对内源性胰岛素的自身抗体引起自发性低血糖发作。这里,我们介绍一例66岁男性多关节疼痛和头晕，最初被怀疑是胰岛素瘤。然而,进一步的测试证实了IAS的存在。患者的关节疼痛波动，但随着血糖水平的控制而改善。虽然IAS和关节痛之间的直接关系还没有很好地确定，患有单一自身免疫性疾病的个体可能并发自身免疫性疾病。关节疼痛在自身免疫性疾病患者中普遍存在。尽管低血糖可能由于应激反应而导致肌肉痉挛，肌肉骨骼直接损伤并不常见。这个案例强调了鉴别诊断的重要性,特别是在区分胰腺癌和胰腺B细胞的良性增殖方面。胰岛素自身抗体水平升高证实了IAS，而胰腺癌可能表现出各种症状和升高的癌症抗原（CA）19-9。全科医生应全面调查低血糖病例，特别是那些与胰腺肿大有关的，并不断监测潜在的恶性肿瘤。
