Alpha lipoic acid와 연관된 인슐린자가면역증후군 1예
A case of insulin autoimmune syndrome related to alpha-lipoic acid
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초록
당뇨병으로 경구 혈당 강하제 복용 중에 발생한 저혈당으로 내원한 71세 여자에서 혈청 인슐린 수치와 인슐린자가 항체가 높게 측정되어 인슐린자가면역증후군으로 진단하였다. 약 4주 전부터 sulfhydryl기가 있는 치옥타시드를 복용하였고, HLA 분석결과 인슐린자가면역증후군에서 추출되는 Cw4, DRB1*0406이 나와 확진할 수 있었으며 프레드니솔론 투여로 저혈당 증세는 호전되었다. 이미 당뇨병으로 치료 중인 환자에서는 빈번한 저혈당이 온다고 해도 인슐린자가면역증후군을 고려하기 쉽지 않지만 전 세계적으로 동아시아 지역에서 유병률이 높은 것을 감안하면 이 질환을 염두 해 두어야 할 것이다.
Abstract
Insulin autoimmune syndrome is characterized by spontaneous hypoglycemia, high concentrations of serum immunoreactive insulin, and the presence of autoantibodies to insulin without previous insulin injection. A 71-year-old woman with diabetes, who had been treated with oral hypoglycemic agents, suffered from frequent hypoglycemia. High insulin levels and the presence of insulin autoantibodies were shown, so insulin autoimmune syndrome was diagnosed. Drugs containing sulfhydryl groups play an important role in the pathogenesis of insulin autoimmune syndrome. Alpha-lipoic acid, which contains a sulfhydryl group, was administered before the onset of hypoglycemia. The patient’s human leukocyte antigen (HLA) type was HLA-Cw4 and DRB1*0406. There is a strong correlation between HLA-DRB1*0406 and insulin autoimmune syndrome. The patient was treated with prednisolone and has not had a hypoglycemic attack since. We report a case of insulin autoimmune syndrome, possibly associated with alpha-lipoic acid.
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