Hypoglycemia due to an insulin binding antibody in a patient with an IgA-kappa myeloma.
J Clin Endocrinol Metab
; 92(6): 2013-6, 2007 Jun.
Article
em En
| MEDLINE
| ID: mdl-17405845
ABSTRACT
CONTEXT Autoantibodies to insulin have been described to cause spontaneous hypoglycemia in nondiabetic subjects. There have been occasional reports of spontaneous hypoglycemia due to monoclonal anti-insulin antibodies. We present the first report of a patient with an IgA-kappa myeloma in whom frequent hypoglycemia resulted from the ability of the monoclonal IgA-kappa to bind insulin. OBJECTIVES:
The aim of this study was to describe the occurrence of profound hypoglycemia in a patient with IgA-kappa myeloma, characterize biochemically the nature of the IgAinsulin complex present, and place this case in the context of the published literature on hypoglycemia resulting from autoantibodies to insulin.DESIGN:
A case study was performed. PATIENTS A single case of profound hypoglycemia associated with IgA-kappa myeloma was studied. INTERVENTION There were no interventions. MAIN OUTCOMEMEASURES:
A case study was performed.RESULTS:
Polyethylene glycol precipitation and gel filtration chromatography were used to demonstrate high-molecular weight insulin immunoreactivity in the patient's plasma. This was characterized as an insulin binding IgA-kappa paraprotein present at 4200 mg/dl (42 g/liter) with a relatively high insulin dissociation constant of 0.32 microm/liter using radiolabelled insulin binding studies.CONCLUSIONS:
We present the first case of hypoglycemia due to IgA binding insulin antibodies in a patient with an IgA-kappa paraprotein myeloma. The hypoglycemia was associated with high-plasma insulin levels and relatively low C-peptide levels. A plausible mechanism for the hypoglycemia is the delayed clearance of insulin. This case broadens the spectrum of monoclonal gammopathies that have been associated with anti-insulin reactivity and spontaneous hypoglycemia.
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Coleções:
01-internacional
Base de dados:
MEDLINE
Tipo de estudo:
Etiology_studies
Limite:
Aged
/
Humans
/
Male
Idioma:
En
Ano de publicação:
2007
Tipo de documento:
Article