Analytical and clinical challenges in a patient with concurrent type 1 diabetes, subcutaneous insulin resistance and insulin autoimmune syndrome

被引:27
作者
Jassam, N. [1 ]
Amin, N. [2 ]
Holland, P. [2 ]
Semple, R. K. [3 ]
Halsall, D. J. [4 ]
Wark, G. [5 ]
Barth, J. H. [6 ]
机构
[1] Harrogate Dist Hosp, Harrogate HG2 7SX, England
[2] Leeds Childrens Hosp NHS Trust, Leeds, W Yorkshire, England
[3] Cambridge Univ Hosp, Wellcome Trust, Cambridge, England
[4] Addenbrookes Hosp, Dept Clin Biochem, Cambridge, England
[5] Royal Surrey Cty Hosp, SAS Peptides Hormone Sect, Surrey, England
[6] Leeds Teaching Hosp NHS Trust, Blood Sci Dept, Leeds, W Yorkshire, England
基金
英国惠康基金; 英国医学研究理事会;
关键词
D O I
10.1530/EDM-13-0086
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
A lean 15-year-old girl was diagnosed with type 1 diabetes based on symptomatic hyperglycaemia and positive anti-islet cell antibodies. Glycaemia was initially stabilised on twice-daily mixed insulin. After 11 months from the time of diagnosis, she complained of hyperglycaemia and ketosis alternating with hypoglycaemia. This progressively worsened until prolonged hospital admission was required for treatment of refractory hypoglycaemia. A high titre of anti-insulin antibodies was detected associated with a very low recovery of immunoreactive (free) insulin from plasma after precipitation with polyethylene glycol, suggesting the presence of insulin in bound complexes. Insulin autoimmune syndrome was diagnosed and metabolic fluctuations were initially managed supportively. However, due to poor glucose control, immunosuppressive therapy was initiated first with steroids and plasmapheresis and later with anti-CD20 antibody therapy (Rituximab). This treatment was associated with a gradual disappearance of anti-insulin antibodies and her underlying type 1 diabetes has subsequently been successfully managed with an insulin pump.
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页数:8
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