Insulin autoimmunity as a cause of hypoglycemia

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Abstract
Autoimmune hypoglycemia is a syndrome consisting of fasting hypoglycemia, hyperinsulinemia and insulin-binding antibodies in a patient who was never exposed to exogenous insulin. The stimulus for insulin-antibody formation and the mechanism of the hypoglycemia in this condition remain unknown. Three patients with this rare syndrome had severe hypoglycemia of limited duration. Two had received a drug containing a SH group (methimazole and penicillamine) as treatment for an autoimmune disorder (Graves'' disease and rheumatoid arthritis, respectively). A 3rd patient who underwent surgery for a suspected insulinoma was found to have pancreatic .beta. cell hyperplasia. Drugs containing a SH group may have a role in the etiology of the syndrome. A relationship is suggested between circulating insulin antibodies and .beta. cell hyperplasia.