甲巯咪唑治疗甲亢引发自身免疫性低血糖症1例.doc

胰岛素自身免疫综合征的诊断和治疗：附1例报告及文献复习 艾智华，胡朝恩，钟大鹏 （610083 成都，成都军区总医院内分泌科） [摘要] 目的 探讨胰岛素自身免疫综合征（insulin autoimmune syndrome,IAS）的发病机制、临床表现、诊断方法和治疗措施，提高临床医师对该病的认识。方法 我院收治1例中年男性患者，反复发生低血糖性昏迷，诊断为IAS，结合相关文献复习，对该病的临床特点进行分析。结果 患者因“Graves病”服用“甲巯咪唑”治疗1个月后，出现“Whipple”三联征，75g葡萄糖耐量试验发现血糖水平升高，而空腹及餐后免疫活性胰岛素显著增高，餐后胰岛素大于1000 mU/L。患者胰岛素自身抗体（IAA）阳性。停用甲巯咪唑后，给予泼尼松30mg/d治疗，并逐渐减量，患者低血糖症状缓解，1年后复查血糖和胰岛素水平恢复正常，IAA阴性。结论 IAS是一种导致低血糖反复发作的少见病因，可由“甲巯咪唑”引起，胰岛素水平和胰岛素自身抗体的测定有助于诊断。 [关键词] 胰岛素自身免疫综合征；甲巯咪唑；胰岛素自身抗体；高胰岛素血症；低血糖症 [中图法分类号] [文献标志码] A Diagnosis and treatment of insulin autoimmune syndrome : a case report and literature review Ai Zhihua，Hu Zhaoen，Zhong Dapeng(Department of Endocrinology , Chengdu Military General Hospital, Chengdu 610083 ,China) [Abstract] Objective Discussing the etiology,diagnosis and treatment of insulin autoimmune syndrome (IAS)，in order to improve the reorganization of clinical physicians．Methods The patient，a adult man，suffered from hypoglycemia frequently．He was finally diagnosed as IAS in Chengdu Military General Hospital．The clinical feature of the case was analyzed in combination with literature review．Results The IAS case had clinical symptoms of Whipple triad，after using methimazole for a month to treat Graves′disease．The results of 75g OGTT test showed that serum glucose increased，both fasting and postprandial serum insulin increased，the postprandial serum insulin level was higher than 1000 mU/ L．The results of Insulin autoantibody (IAA) was positive. The methimazole was not employed and prednisone 30 mg/ d was used，with the dosage being gradually reduced．The symptoms of hypoglycemia diminished，with the recovery of plasma glucose and insulin levels．Conclusion　IAS is a rare disease which may result in a case of repeated episode of hypoglycemia. It can be caused by methimazole . To assay serum insulin and insulin autoantibody are greatly helpful to distinguish IAS. [Key words] insulin autoimmune syndrome; methimazole; insulin autoantib