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Case Reports
. 2022 Feb;63(2):217-220.
doi: 10.1007/s00108-021-01180-0. Epub 2021 Oct 26.

[Insulin autoimmune syndrome : A rare, but important differential diagnosis of hypoglycemia]

[Article in German]
Tiago de Castro  1 , Christoph Beier  1 , Christoph Terkamp  1 , Lucia Oehler  2 , Bernhard M W Schmidt  2 , Johannes Heck  3 , Dirk Stichtenoth  3 , Heiner Wedemeyer  1 , Holger Leitolf  4
Affiliations
Case Reports

[Insulin autoimmune syndrome : A rare, but important differential diagnosis of hypoglycemia]

[Article in German]
Tiago de Castro et al. Internist (Berl). 2022 Feb.

Abstract
in English, German

A 69-year-old female patient was referred to the Medical University of Hanover for further diagnostic evaluation of recurrent severe hypoglycemia. The patient had previously been started on clopidogrel after arterial stenting for peripheral arterial obstructive disease (PAOD). The presence of an insulinoma and paraneoplastic syndrome was excluded. Increased serum insulin and insulin autoantibodies levels were confirmed, despite normal to low blood sugar levels. An insulin autoimmune syndrome was diagnosed, most likely induced by the prior intake of clopidogrel. Treatment with immunoadsorption was initiated, achieving a significant reduction in hypoglycemic events and a lasting response to treatment over 3 months.

Eine 69-jährige Patientin mit rezidivierenden schweren Hypoglykämien wurde zur weiteren Diagnostik der Medizinischen Hochschule Hannover zugewiesen. Zuvor hatte die Patientin nach einem Stenting, das aufgrund einer peripheren arteriellen Verschlusskrankheit (pAVK) erforderlich war, mit einer Clopidogreleinnahme begonnen. Das Vorliegen eines Insulinoms und eines paraneoplastischen Syndroms wurde ausgeschlossen. Trotz niedrig normaler Blutzuckerkonzentrationen fanden sich erhöhte Insulin- und Insulinautoantikörperkonzentrationen. Diagnostiziert wurde ein Insulinautoimmunsyndrom, a.e. (am ehesten) ausgelöst durch vorausgegangene Clopidogreleinnahme. Eine Behandlung mithilfe der Immunadsorption wurde initiiert; diese erzielte eine signifikante Reduktion der hypoglykämischen Ereignisse und ein anhaltendes Therapieansprechen über 3 Monate.

Keywords: Clopidogrel; Hyperinsulinism; Hypoglycemia; Immunoadsorption; Insulin.

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