Type B insulin-resistance syndrome presenting as autoimmune hypoglycemia, associated with systemic lupus erythematosus and interstitial lung disease.
10.3904/kjim.2013.28.1.98
- Author:
Seon Mee KANG
1
;
Heung Yong JIN
;
Kyung Ae LEE
;
Ji Hyun PARK
;
Hong Sun BAEK
;
Tae Sun PARK
Author Information
1. Division of Endocrinology and Metabolism, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
- Publication Type:Case Reports
- Keywords:
Autoimmune hypoglycemia;
Lupus erythematosus, systemic;
Lung diseases, interstitial
- MeSH:
Adult;
Autoantibodies/*blood;
*Autoimmunity;
Biological Markers/blood;
Blood Glucose/metabolism;
Female;
Humans;
Hypoglycemia/blood/*complications/immunology;
Insulin/blood;
*Insulin Resistance;
Lung Diseases, Interstitial/diagnosis/*etiology/immunology/surgery;
Lupus Erythematosus, Systemic/*complications/diagnosis/immunology;
Receptor, Insulin/*immunology;
Thoracic Surgery, Video-Assisted;
Tomography, X-Ray Computed;
Treatment Outcome
- From:The Korean Journal of Internal Medicine
2013;28(1):98-102
- CountryRepublic of Korea
- Language:English
-
Abstract:
We describe an unusual case of systemic lupus erythematosus with pulmonary manifestations presenting as hypoglycemia due to anti-insulin receptor antibodies. A 38-year-old female suffered an episode of unconsciousness and was admitted to hospital where her blood glucose was found to be 18 mg/dL. During the hypoglycemic episode, her serum insulin level was inappropriately high (2,207.1 pmol/L; normal range, 18 to 173) and C-peptide level was elevated (1.7 nmol/L; normal range, 0.37 to 1.47). Further blood tests revealed the presence of antinuclear antibodies, anti-double-stranded DNA antibodies, and anti-Ro/SSA, anti-La/SSB, anti-ribonucleoprotein, and anti-insulin receptor antibodies. A computed tomography scan of the abdomen, aimed at tumor localization, such as an insulinoma, instead revealed ground-glass opacities in both lower lungs, and no abnormal finding in the abdomen. For a definitive diagnosis of the lung lesion, video-associated thoracoscopic surgery was performed and histopathological findings showed a pattern of fibrotic non-specific interstitial pneumonia.
