Methimazole-Induced Insulin Autoimmune Syndrome in a Korean Patient with Graves’ Disease Treated with Propylthiouracil: a Case Report and Literature Review
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Insulin autoimmune syndrome (IAS) is rare. Herein, we report a case of methimazole-induced IAS successfully treated with propylthiouracil (PTU) and review related literature on Korean cases. A 48-year-old woman visited our hospital due to a hypoglycemic mental alteration. She had been taking medications for Graves’ disease including methimazole. Laboratory tests revealed a low serum glucose, high insulin, C-peptide, and anti-insulin antibody titer level. Abdominal computed tomography was negative for pancreatic tumors. Therefore, the patient was diagnosed with methimazole-induced IAS. After methimazole discontinuation and frequent diet, her hypoglycemic symptoms improved. She was treated with PTU for Graves’ disease. Previously, six cases of methimazole-induced IAS have been reported in Korea. Our case was the first in Korea to respond well to medical therapy (PTU) without other hypoglycemic treatments, such as steroids. PTU, which does not contain a sulfhydryl group, can be an option for the treatment of Graves’ disease and methimazole-induced IAS.
Abstract
Insulin autoimmune syndrome (IAS) is rare. Herein, we report a case of methimazole-induced IAS successfully treated with propylthiouracil (PTU) and review related literature on Korean cases. A 48-year-old woman visited our hospital due to a hypoglycemic mental alteration. She had been taking medications for Graves’ disease including methimazole. Laboratory tests revealed a low serum glucose, high insulin, C-peptide, and anti-insulin antibody titer level. Abdominal computed tomography was negative for pancreatic tumors. Therefore, the patient was diagnosed with methimazole-induced IAS. After methimazole discontinuation and frequent diet, her hypoglycemic symptoms improved. She was treated with PTU for Graves’ disease. Previously, six cases of methimazole-induced IAS have been reported in Korea. Our case was the first in Korea to respond well to medical therapy (PTU) without other hypoglycemic treatments, such as steroids. PTU, which does not contain a sulfhydryl group, can be an option for the treatment of Graves’ disease and methimazole-induced IAS.
참고문헌 (16)
- Shao Y, "The association between hypoglycemia and mortality in sepsis and septic shock : a systematic review and meta-analysis", Adv Clin Exp Med, 33(3), pp.197~205 (2024)
- Basu A, "Insulin autoimmunity and hypoglycemia in seven white patients", Endocr Pract, 11(2), pp.97~103 (2005)
- Lee KS, "A case report of insulin autoimmune syndrome in Graves' disease", J Korean Soc Endocrinol, 8, pp.451~455 (1993)
- Lim JK, "Ensulin autoimmune syndrome in a patient with methimazoletreated Graves’ disease : a case report", J Korean Soc Endocrinol, 13, pp.612~616 (1998)
- Lee SH, "Insulin autoimmune syndrome in a Korean girl with Graves’ disease", Ann Pediatr Endocrinol Metab, 18, pp.32~35 (2013)
- Roh E, "Two cases of methimazole-induced insulin autoimmune syndrome in Graves’ disease", Endocrinol Metab, 28, pp.55~60 (2013)
- Uchigata Y, "Insulin autoimmune syndrome(Hirata disease) : clinical features and epidemiology in Japan", Diabetes Res Clin Pract, 22(2-3), pp.89~94 (1994)
- Woo CY, "Clinical features and causes of endogenous hyperinsulinemic hypoglycemia in Korea", Diabetes Metab J, 39(2), pp.126~131 (2015)
- Lupsa BC, "Autoimmune forms of hypoglycemia", Medicine(Baltimore), 88(3), pp.141~153 (2009)
- Hirata Y, "Methimazole and insulin autoimmune syndrome with hypoglycemia", Lancet, 2(8357), pp.1037~1038 (1983)
- Uchigata Y, "Strong association of insulin autoimmune syndrome with HLA-DR4", Lancet, 339(8790), pp.393~394 (1992)
- Uchigata Y, "Patients with Graves' disease who developed insulin autoimmune syndrome(Hirata disease)possess HLA-Bw62", Cw4, J Clin Endocrinol Metab, pp.1993, 77(1)[DOI]
- Uchigata Y, "Worldwide differences in the incidence of insulin autoimmune syndrome(Hirata disease)with respect to the evolution of HLA-DR4 alleles", Hum Immunol, 61(2), pp.154~157 (2000)
- Eisenbarth GS, "Immunoendocrinology: scientific and clinical aspects", pp.343~367 (2011), Springer Science+Business Media
- Yaturu S, "Severe autoimmune hypoglycemia with insulin antibodies necessitating plasmapheresis", Endocr Pract, 10(1), pp.49~54 (2004)
- Yu L, "Rituximab selectively suppresses specific islet antibodies", Diabetes, 60(10), pp.2560~2565 (2011)