A case of insulin autoimmune syndrome associated with small insulinomas and rheumatoid arthritis.

Publisher Website
Google Scholar
Abstract
Twenty five cases of insulin autoimmune syndrome were reported without having the pathogenesis clarified. This paper describes a case which suggests 1 aspect of pathogenesis. The patient concurrently had insulinoma and severe rheumatoid arthritis, complaining of hypoglycemic syncope attacks. During the attacks her blood sugar levels were 19-22 mg%. Her serum extractable immunoreactive insulin (IRI) and insulin binding antibody levels were 557 .mu.U/ml and 0.390 mU/ml, respectively. .gamma.-Globulin-bound insulin was also measured electrophoretically. Bio-Gel P 10 column chromatography eluted almost all IRI at the void volume at pH 7.4 and a smaller but significant IRI peak also at pH 3.0. Selective angiography revealed a tumor-like staining in the pancreas body. Pancreatectomy relieved her of hypoglycemic attacks. Histology disclosed 2 small insulinomas. Insulinoma, rheumatoid arthritis and insulin autoimmune syndrome coexisted in this case, suggesting some causal relationship among them.