Chonnam Med J.
2006 Dec;42(3):202-206.
Severe Persistent Hypoglycemia due to Insulin Autoimmune Syndrome and Adrenal Insufficiency: A Case Report
- Affiliations
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- 1Department of Internal Medicine, Chonnam National University Medical School, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea. mychung@chonnam.ac.kr
Abstract
- The insulin autoimmune syndrome and the deficiencies of counterregulatory hormones can lead to hypoglycemia. We report a rare case of severe hypoglycemia with insulin autoimmune syndrome and concomitant adrenal insufficiency. An 86-year-old woman was admitted with a history of recurrent episodes of hypoglycemia. She had received intermittent injections of glucocorticoid preparations for treatment of polyarthralgia over several years. When hypoglycemic symptoms developed, the plasma glucose was decreased as low as 20 mg/dl with the plasma cortisol level 9.1microgram/dl. Insulin auto-antibodies were positive. The cortisol response to ACTH was diminished. She received a continuous infusion of 10% dextrose solution in addition to frequent low carbohydrate meals; however, she continued to experience recurrent symptoms of hypoglycemia, and required frequent intravenous infusion of 50% dextrose. The hypoglycemia resolved upon prescribing prednisolone 30 mg per day.
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