Hypoglycemia due to an Insulin Binding Antibody in a Patient with an IgA-κ Myeloma
Open Access
- 1 June 2007
- journal article
- case report
- Published by The Endocrine Society in Journal of Clinical Endocrinology & Metabolism
- Vol. 92 (6), 2013-2016
- https://doi.org/10.1210/jc.2007-0075
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-κ myeloma in whom frequent hypoglycemia resulted from the ability of the monoclonal IgA-κ to bind insulin. Objectives: The aim of this study was to describe the occurrence of profound hypoglycemia in a patient with IgA-κ myeloma, characterize biochemically the nature of the IgA:insulin 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-κ myeloma was studied. Intervention: There were no interventions. Main Outcome Measures: 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-κ paraprotein present at 4200 mg/dl (42 g/liter) with a relatively high insulin dissociation constant of 0.32 μm/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-κ 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.Keywords
This publication has 13 references indexed in Scilit:
- Insulin autoimmune syndrome due to IgG kappa paraproteinPathology, 2004
- Best Practice No 173: Clinical and laboratory investigation of adult spontaneous hypoglycaemiaJournal of Clinical Pathology, 2003
- Hypoglycaemia due to insulin autoimmune syndrome: report of two cases with characterisation of HLA alleles and insulin autoantibodiesActa Endocrinologica, 2001
- Identification of Monoclonal Insulin Autoantibodies in Insulin Autoimmune Syndrome Associated with HLA-DRB1*0401Hormone Research in Paediatrics, 2000
- Differential Immunogenetic Determinants of Polyclonal Insulin Autoimmune Syndrome (Hirata's Disease) and Monoclonal Insulin Autoimmune SyndromeDiabetes, 1995
- Longitudinal Changes of Serum Insulin Concentration and Insulin Antibody Features in Persistent Insulin Autoimmune Syndrome (Hirata's Disease)Autoimmunity, 1994
- Hypoglycaemia caused by atypical insulin antibodies in a patient with benign monoclonal gammopathyJournal of Internal Medicine, 1993
- Brief Report: Hypoglycemia Due to a Monoclonal Insulin-Binding Antibody in Multiple MyelomaThe New England Journal of Medicine, 1992
- Insulin Autoimmune Syndrome Associated With Benign Monoclonal Gammopathy: Evidence for Monoclonal Insulin AutoantibodiesDiabetes Care, 1989
- Equilibrium Binding Assay and Kinetic Characterization of Insulin AntibodiesDiabetes, 1978