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- Title
Pseudoinsulinoma in a White Man With Autoimmune Hypoglycemia Due to Anti-Insulin Antibodies.
- Authors
Arzamendi, Audrey E.; Rajamani, Uthra; Jialal, Ishwarlal
- Abstract
Objectives: Insulin autoimmune syndrome (IAS) is an extremely rare cause of hypoglycemia, particularly in non-Asian populations. Methods: In this report, we describe a white male patient with elevated total insulin (>100.0 µIU/mL), C-peptide, and proinsulin levels who was diagnosed with IAS due to anti-insulin antibodies. He also had a small IgG κ M-protein. Results: We show that anti-insulin antibodies and/or the monoclonal protein can significantly interfere with insulin and C-peptide immunoassays and propose polyethylene glycol precipitation to quantitate free C-peptide levels as a useful assay in differentiating IAS due to anti-insulin antibodies from insulinoma. Conclusions: In patients presenting with hypoglycemia with excessively high insulin levels, consideration needs to be given to autoimmune hypoglycemia due to anti-insulin antibodies as a cause. Additionally, if total C-peptide levels are increased, free C-peptide needs to be quantitated following polyethylene glycol precipitation.
- Subjects
INSULINOMA; ISLET cell tumor; WHITE men; HYPOGLYCEMIA; BLOOD sugar
- Publication
American Journal of Clinical Pathology, 2014, Vol 142, Issue 5, p689
- ISSN
0002-9173
- Publication type
Article
- DOI
10.1309/AJCPX56JQBJHUBGJ