What is known and objective Alpha-lipoic acid (ALA) is widely used as a dietary supplement and antiageing agent. Insulin autoimmune syndrome (IAS) is the most serious adverse reaction reported with the use of ALA. The purpose of this study was to explore the clinical characteristics of ALA-induced IAS and provide a scientific reference for clinical diagnosis, treatment and prevention. Methods We collected literature on IAS cases induced by ALA for retrospective analysis in Chinese and English. Results and discussion The median age of 37 patients (28 females and 9 males) was 61 years (range 32-82). The symptoms occurred at night and in the early morning (60.7%), in the late postprandial period (50.0%) or after fasting (35.7%), within hours in some patients and up to 2 months in others after stopping ALA or during medication treatment. Autonomic nervous system symptoms (81.1%) and neurological hypoglycaemia (64.9%) are the main clinical manifestations of hypoglycaemia. The blood glucose concentration at the onset of hypoglycaemia was 2.19 mmol/L (median, range 1.09-3.52), the insulin concentration was >= 100 mu IU/ml (94.6%), and the C-peptide concentration was <= 20 ng/ml (83.3%). Testing for IgG insulin autoantibodies (IAAs) was positive in 37 patients. Pancreatic imaging was unremarkable on computed tomography (CT), magnetic resonance imaging (MRI) and abdominal sonography. Hypoglycaemia disappeared within 5 days to 8 months after withdrawing ALA alone or using corticosteroid treatment. IAA turned negative in 7 months (median; range 2-36). Follow-up showed no recurrent hypoglycaemic episodes at 7.25 months (median; range 1-36). What is new and conclusion ALA-induced IAS is a clinically rare autoimmune disease with hypoglycaemia that occurs during medication treatment or after drug withdrawal that should be treated promptly.
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Univ Cattolica Sacro Cuore, Paolo VI Int Sci Inst, Rome, ItalyUniv Cattolica Sacro Cuore, Paolo VI Int Sci Inst, Rome, Italy
Di Nicuolo, Fiorella
D'Ippolito, Silvia
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Fdn Policlin Univ A Gemelli IRCCS, UOC Ostetricia & Patol Ostetr, Dipartimento Sci Salute Donna Bambino & Sanita Pu, Largo F Vito 1, I-00168 Rome, Italy
Univ Cattolica Sacro Cuore, Ist Clin Ostetr & Ginecol, Rome, ItalyUniv Cattolica Sacro Cuore, Paolo VI Int Sci Inst, Rome, Italy
D'Ippolito, Silvia
Castellani, Roberta
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Univ Cattolica Sacro Cuore, Ist Clin Ostetr & Ginecol, Rome, ItalyUniv Cattolica Sacro Cuore, Paolo VI Int Sci Inst, Rome, Italy
Castellani, Roberta
Rossi, Esther Diana
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Fdn Policlin Univ A Gemelli IRCCS, UOC Anat Patol, Dipartimento Sci Salute Donna Bambino & Sanita Pu, Rome, ItalyUniv Cattolica Sacro Cuore, Paolo VI Int Sci Inst, Rome, Italy
Rossi, Esther Diana
Masciullo, Valeria
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Univ Cattolica Sacro Cuore, Ist Clin Ostetr & Ginecol, Rome, Italy
Fdn Policlin Univ A Gemelli IRCCS, UOC Ginecol Oncol, Dipartimento Sci Salute Donna Bambino & Sanita Pu, Rome, ItalyUniv Cattolica Sacro Cuore, Paolo VI Int Sci Inst, Rome, Italy
Masciullo, Valeria
Specchia, Monia
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Univ Cattolica Sacro Cuore, Ist Clin Ostetr & Ginecol, Rome, ItalyUniv Cattolica Sacro Cuore, Paolo VI Int Sci Inst, Rome, Italy
Specchia, Monia
Mariani, Marco
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Univ Cattolica Sacro Cuore, Ist Sanita Pubbl, Sez Igiene, Rome, ItalyUniv Cattolica Sacro Cuore, Paolo VI Int Sci Inst, Rome, Italy
Mariani, Marco
Pontecorvi, Alfredo
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Univ Cattolica Sacro Cuore, Paolo VI Int Sci Inst, Rome, Italy
Fdn Policlin Univ A Gemelli IRCCS, UOC Endocrinol & Diabetol, Dipartimento Sci Gastroenterol Endocrino Metabo, Rome, Italy
Univ Cattolica Sacro Cuore, Ist Patol Med, Rome, ItalyUniv Cattolica Sacro Cuore, Paolo VI Int Sci Inst, Rome, Italy
Pontecorvi, Alfredo
Scambia, Giovanni
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Univ Cattolica Sacro Cuore, Ist Clin Ostetr & Ginecol, Rome, Italy
Fdn Policlin Univ A Gemelli IRCCS, UOC Ginecol Oncol, Dipartimento Sci Salute Donna Bambino & Sanita Pu, Rome, ItalyUniv Cattolica Sacro Cuore, Paolo VI Int Sci Inst, Rome, Italy
Scambia, Giovanni
Di Simone, Nicoletta
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Fdn Policlin Univ A Gemelli IRCCS, UOC Ostetricia & Patol Ostetr, Dipartimento Sci Salute Donna Bambino & Sanita Pu, Largo F Vito 1, I-00168 Rome, Italy
Univ Cattolica Sacro Cuore, Ist Clin Ostetr & Ginecol, Rome, ItalyUniv Cattolica Sacro Cuore, Paolo VI Int Sci Inst, Rome, Italy
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UNIV LONDON QUEEN MARY & WESTFIELD COLL, DEPT PHARMACOL, LONDON E1 4NS, ENGLANDUNIV LONDON QUEEN MARY & WESTFIELD COLL, DEPT PHARMACOL, LONDON E1 4NS, ENGLAND
Garrett, NE
Malcangio, M
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UNIV LONDON QUEEN MARY & WESTFIELD COLL, DEPT PHARMACOL, LONDON E1 4NS, ENGLANDUNIV LONDON QUEEN MARY & WESTFIELD COLL, DEPT PHARMACOL, LONDON E1 4NS, ENGLAND
Malcangio, M
Dewhurst, M
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UNIV LONDON QUEEN MARY & WESTFIELD COLL, DEPT PHARMACOL, LONDON E1 4NS, ENGLANDUNIV LONDON QUEEN MARY & WESTFIELD COLL, DEPT PHARMACOL, LONDON E1 4NS, ENGLAND
Dewhurst, M
Tomlinson, DR
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UNIV LONDON QUEEN MARY & WESTFIELD COLL, DEPT PHARMACOL, LONDON E1 4NS, ENGLANDUNIV LONDON QUEEN MARY & WESTFIELD COLL, DEPT PHARMACOL, LONDON E1 4NS, ENGLAND