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Hypoglycaemia caused by atypical insulin antibodies in a patient with benign monoclonal gammopathy

Arnqvist, H. J.
Mathiesen, U. L.
Zahnd, G.
von Schenck, H.
Published in Journal of Internal Medicine. 1993, vol. 234, no. 4, p. 421-427
Abstract We describe a 48-year-old woman with recurrent severe hypoglycaemia apparently caused by a paraprotein with insulin-binding capacity. Very high fasting values were found for serum insulin (170 and > 250 mU l-1) as well as for proinsulin 125 pmol l-1 and an insulinoma was suspected. Hypoglycaemia developed after an oral glucose tolerance (OGTT) test but not during fasting for 48 h. Free insulin and C-peptide were normal during OGTT whereas serum insulin was very high. 125I-insulin binding to serum, determined with a polyethylene glycol (PEG) precipitation method was high (40%), and equally high after addition of 1.7 x 10(-5) mol l-1 cold insulin to estimate non-specific binding. By adding very high concentrations of cold insulin, displacement of 125I-insulin bound to serum was found (50% displacement at 4 x 10(-5) mol l-1). No immunoglobulin G (IgG) insulin antibodies were detected by radioimmunoelectrophoresis. On agarose electrophoresis a small paraprotein (4 g l-1) in the gamma-globulin fraction was detected. 125I-insulin binding to this paraprotein was demonstrated. We conclude that if insulin autoantibodies are suspected as a cause of hypoglycaemia screening for insulin antibodies should always be done with a PEG-precipitation method.
Keywords Autoantibodies/ bloodFemaleHumansHypoglycemia/ immunologyInsulin/bloodInsulin Antibodies/ bloodMiddle AgedMonoclonal Gammopathy of Undetermined Significance/ complications/immunology
PMID: 8409840
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ARNQVIST, H. J. et al. Hypoglycaemia caused by atypical insulin antibodies in a patient with benign monoclonal gammopathy. In: Journal of Internal Medicine, 1993, vol. 234, n° 4, p. 421-427. doi: 10.1111/j.1365-2796.1993.tb00766.x https://archive-ouverte.unige.ch/unige:9134

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Deposited on : 2010-07-12

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