Resolution of dysglycaemia after treatment of monoclonal gammopathy of endocrine significance.
Eur J Endocrinol
; 189(6): K25-K29, 2023 Dec 06.
Article
em En
| MEDLINE
| ID: mdl-37818852
ABSTRACT
In very rare cases of monoclonal gammopathy, insulin-binding paraprotein can cause disabling hypoglycaemia. We report a 67-year-old man re-evaluated for hyperinsulinaemic hypoglycaemia that persisted despite distal pancreatectomy. He had no medical history of diabetes mellitus or autoimmune disease but was being monitored for an IgG kappa monoclonal gammopathy of undetermined significance. On glucose tolerance testing, hyperglycaemia occurred at 60â
min (glucose 216â
mg/dL) and hypoglycaemia at 300â
min (52â
mg/dL) concurrent with an apparent plasma insulin concentration of 52 850â
pmol/L on immunoassay. Laboratory investigation revealed an IgG2 kappa with very high binding capacity but low affinity (Kd 1.43 × 10-6â
mol/L) for insulin. The monoclonal gammopathy was restaged as smouldering myeloma not warranting plasma cell-directed therapy from a haematological standpoint. Plasma exchange reduced paraprotein levels and improved fasting capillary glucose concentrations. Lenalidomide was used to treat disabling hypoglycaemia, successfully depleting paraprotein and leading to resolution of symptoms.
Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Paraproteinemias
/
Gamopatia Monoclonal de Significância Indeterminada
/
Doenças do Sistema Endócrino
/
Hipoglicemia
/
Mieloma Múltiplo
Limite:
Aged
/
Humans
/
Male
Idioma:
En
Revista:
Eur J Endocrinol
Ano de publicação:
2023
Tipo de documento:
Article