하시모토 갑상선염 환자에서의 인슐린자가면역증후군 1예
Insulin Autoimmune Syndrome in a Patient with Hashimoto’s Thyroiditis
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Insulin autoimmune syndrome (IAS) is characterized by fasting hypoglycemia, endogenous hyperinsulinemia, and the presence of autoantibodies to insulin or insulin receptor in patients that have never been exposed to exogenous insulin. This syndrome is occasionally accompanied by several autoimmune disorders. There is no reported case of concurrent IAS with Hashimoto's thyroiditis. A 52-year-old female was diagnosed with Hashimoto’s thyroiditis and was treated with 25 μg/d levothyroxine for 3 years. Recently, she experienced recurrent fasting hypoglycemic symptoms that disappeared rapidly with a carbohydrate-rich diet, although she had no history of diabetes or insulin use. Blood analysis showed hypoglycemia and elevated serum levels of insulin and C-peptide. Imaging studies did not reveal a mass lesion in the pancreas, and selective calcium-stimulated venous sampling also gave a negative result. However, anti-insulin antibody titer was high and assay for anti-insulin receptor antibody was positive. Here, we report a case of IAS concomitant with Hashimoto’s thyroiditis.
Abstract
Insulin autoimmune syndrome (IAS) is characterized by fasting hypoglycemia, endogenous hyperinsulinemia, and the presence of autoantibodies to insulin or insulin receptor in patients that have never been exposed to exogenous insulin. This syndrome is occasionally accompanied by several autoimmune disorders. There is no reported case of concurrent IAS with Hashimoto's thyroiditis. A 52-year-old female was diagnosed with Hashimoto’s thyroiditis and was treated with 25 μg/d levothyroxine for 3 years. Recently, she experienced recurrent fasting hypoglycemic symptoms that disappeared rapidly with a carbohydrate-rich diet, although she had no history of diabetes or insulin use. Blood analysis showed hypoglycemia and elevated serum levels of insulin and C-peptide. Imaging studies did not reveal a mass lesion in the pancreas, and selective calcium-stimulated venous sampling also gave a negative result. However, anti-insulin antibody titer was high and assay for anti-insulin receptor antibody was positive. Here, we report a case of IAS concomitant with Hashimoto’s thyroiditis.
참고문헌 (20)
- Weetman AP, "Cellular immune responses in autoimmune thyroid disease", Clin Endocrinol (Oxf), 61(4), pp.405~413 (2004)
- Kamath C, "Thyrotrophin receptor antibody characteristics in a woman with long-standing Hashimoto's who developed Graves' disease and pretibial myxoedema", Clin Endocrinol (Oxf), 77(3), pp.465~470 (2012)
- Takasu N, "Graves' disease following hypothyroidism due to Hashimoto's disease: studies of eight cases", Clin Endocrinol (Oxf), 33(6), pp.687~698 (1990)
- McLachlan SM, "The link between Graves' disease and Hashimoto's thyroiditis: a role for regulatory T cells", Endocrinology, 148(12), pp.5724~5733 (2007)
- Hirata Y, "Insulin autoimmunity in a case of spontaneous hypoglycemia", J Jpn Diabetes Soc, 13, pp.312~320 (1970)
- Takayama-Hasumi S, "Insulin autoimmune syndrome is the third leading cause of spontaneous hypoglycemic attacks in Japan", Diabetes Res Clin Pract, 10(3), pp.211~214 (1990)
- Cho BY, "Spontaneous hypoglycemia and insulin autoantibodies in a patient with Graves' disease", Diabetes Res Clin Pract, 3(3), pp.119~124 (1987)
- 노은연, "Two Cases of Methimazole-Induced Insulin Autoimmune Syndrome in Graves’ Disease", Endocrinology and Metabolism, 28(1), pp.55~60 (2013), 대한내분비학회
- Zhernakova A, "Clinical implications of shared genetics and pathogenesis in autoimmune diseases", Nat Rev Endocrinol, 9(11), pp.646~659 (2013)
- Jameson JL, "Harrison's principles of internal medicine", pp.2920~ (2011), McGraw-Hill
- Uchigata Y, "Strong association of insulin autoimmune syndrome with HLA-DR4", Lancet, 339(8790), pp.393~394 (1992)
- 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)
- van Lummel M, "Changing faces, unmasking the beta-cell: post-translational modification of antigens in type 1 diabetes", Curr Opin Endocrinol Diabetes Obes, 20(4), pp.299~306 (2013)
- Lupsa BC, "Autoimmune forms of hypoglycemia", Medicine (Baltimore), 88(3), pp.141~153 (2009)
- Chun SW, "A case of autoimmune hypoglycemia in the presence of both anti-insulin and anti-insulin receptor antibodies", Korean Clinical Diabetes J, 10(2), pp.123~128 (2009)
- Takeuchi Y, "Insulin autoimmune syndrome possibly caused by alpha lipoic acid", Intern Med, 46(5), pp.237~239 (2007)
- Cryer PE, "Evaluation and management of adult hypoglycemic disorders: an Endocrine Society Clinical Practice Guideline", J Clin Endocrinol Metab, 94(3), pp.709~728 (2009)
- Uchigata Y, "Insulin autoimmune syndrome (Hirata disease): epidemiology in Asia, including Japan", Diabetol Int, 1(1), pp.21~25 (2010)
- 19)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]
- 이가희, "갑상선기능항진증의 진단 및 치료- 대한갑상선학회 합의안", 대한갑상선학회지, 6(1), pp.1~11 (2013), 대한갑상선학회