PDF(Pubmed)
Abstract：
BACKGROUND: Insulin autoantibody syndrome (IAS), or Hirata disease, is caused by high concentrations of insulin autoantibodies, which result in spontaneous, mainly post-prandial, hypoglycemic episodes. We report a case of a previously healthy 67-year-old man presenting with recurrent fasting hypoglycemia culminating in a diagnosis of insulin autoimmune syndrome linked to omeprazole and probably spices, namely, coriander, and ginger.
METHODS: A previously healthy 67-year-old Sinhalese man presented with recurrent syncopal attacks for 3 months, which were found to be hypoglycemic episodes. He experienced mainly fasting hypoglycemic attacks, at a frequency gradually increasing to daily attacks. His cardiovascular, respiratory, abdominal, and neurologic examinations were normal. He was found to have insulin levels > 6000 mU/L and a post-polyethylene glycol insulin recovery of less than 9.5%. Contrast-enhanced computed tomography of the pancreas was normal. The diagnosis of insulin autoantibody syndrome was confirmed by testing for the insulin autoantibody level, yielding a level of > 300 U/mL. With regard to a possible trigger, he had a history of omeprazole intake for 2 weeks, 4 weeks prior to the onset of symptoms. He also consumed an herbal supplement containing coriander and ginger extracts daily for a period of 1 year, approximately 2 years prior to the onset of hypoglycemic attacks. He was commenced on prednisolone 30 mg daily, and hypoglycemic episodes responded dramatically, and thus he was tapered off corticosteroids.
CONCLUSIONS: Omeprazole-induced insulin autoantibody syndrome is likely in this patient; however, the known hypoglycemic effects of coriander and ginger make it worthwhile to consider a possible association with insulin autoantibody syndrome. In addition, this case report highlights the need to consider insulin autoantibody syndrome even in patients presenting with fasting hypoglycemic attacks.
METHODS: A previously healthy 67-year-old Sinhalese man presented with recurrent syncopal attacks for 3 months, which were found to be hypoglycemic episodes. He experienced mainly fasting hypoglycemic attacks, at a frequency gradually increasing to daily attacks. His cardiovascular, respiratory, abdominal, and neurologic examinations were normal. He was found to have insulin levels > 6000 mU/L and a post-polyethylene glycol insulin recovery of less than 9.5%. Contrast-enhanced computed tomography of the pancreas was normal. The diagnosis of insulin autoantibody syndrome was confirmed by testing for the insulin autoantibody level, yielding a level of > 300 U/mL. With regard to a possible trigger, he had a history of omeprazole intake for 2 weeks, 4 weeks prior to the onset of symptoms. He also consumed an herbal supplement containing coriander and ginger extracts daily for a period of 1 year, approximately 2 years prior to the onset of hypoglycemic attacks. He was commenced on prednisolone 30 mg daily, and hypoglycemic episodes responded dramatically, and thus he was tapered off corticosteroids.
CONCLUSIONS: Omeprazole-induced insulin autoantibody syndrome is likely in this patient; however, the known hypoglycemic effects of coriander and ginger make it worthwhile to consider a possible association with insulin autoantibody syndrome. In addition, this case report highlights the need to consider insulin autoantibody syndrome even in patients presenting with fasting hypoglycemic attacks.
摘要：
背景：胰岛素自身抗体综合征（IAS），或者平田病，是由高浓度的胰岛素自身抗体引起的，这导致了自发的，主要是餐后,低血糖发作。我们报告了一例先前健康的67岁男性，表现为反复空腹低血糖，最终诊断为与奥美拉唑和香料相关的胰岛素自身免疫综合征。即,香菜,和姜。
方法：一名健康的67岁僧伽罗人反复发作3个月，被发现是低血糖发作。他主要经历了空腹低血糖发作，频率逐渐增加到日常攻击。他的心血管疾病,呼吸,腹部，神经系统检查正常。发现他的胰岛素水平>6000mU/L，聚乙二醇后胰岛素回收率低于9.5％。胰腺的对比增强计算机断层扫描正常。通过检测胰岛素自身抗体水平证实了胰岛素自身抗体综合征的诊断。产生>300U/mL的水平。关于可能的触发因素，他有服用奥美拉唑2周的病史，症状出现前4周。他还每天食用含有香菜和生姜提取物的草药补充剂，为期1年，大约在低血糖发作前2年。他开始每天服用强的松龙30毫克，低血糖发作反应明显，因此他逐渐减少了皮质类固醇。
结论：奥美拉唑诱导的胰岛素自身抗体综合征可能在该患者中发生；然而，香菜和生姜的已知降血糖作用使得值得考虑可能与胰岛素自身抗体综合征有关。此外,本病例报告强调，即使在出现空腹低血糖发作的患者中，也需要考虑胰岛素自身抗体综合征。
方法：一名健康的67岁僧伽罗人反复发作3个月，被发现是低血糖发作。他主要经历了空腹低血糖发作，频率逐渐增加到日常攻击。他的心血管疾病,呼吸,腹部，神经系统检查正常。发现他的胰岛素水平>6000mU/L，聚乙二醇后胰岛素回收率低于9.5％。胰腺的对比增强计算机断层扫描正常。通过检测胰岛素自身抗体水平证实了胰岛素自身抗体综合征的诊断。产生>300U/mL的水平。关于可能的触发因素，他有服用奥美拉唑2周的病史，症状出现前4周。他还每天食用含有香菜和生姜提取物的草药补充剂，为期1年，大约在低血糖发作前2年。他开始每天服用强的松龙30毫克，低血糖发作反应明显，因此他逐渐减少了皮质类固醇。
结论：奥美拉唑诱导的胰岛素自身抗体综合征可能在该患者中发生；然而，香菜和生姜的已知降血糖作用使得值得考虑可能与胰岛素自身抗体综合征有关。此外,本病例报告强调，即使在出现空腹低血糖发作的患者中，也需要考虑胰岛素自身抗体综合征。
