2024 Volume 67 Issue 7 Pages 275-281
A 69-year-old man with impaired consciousness was brought to the emergency room and admitted to the hospital with a diagnosis of hypoglycemic coma. Initially, insulinoma was suspected but could not be found. Subsequently, the patient showed consistent hyperglycemia and was found to be positive for insulin receptor antibodies, resulting in a diagnosis of insulin receptor dysregulation type B. Steroid therapy was effective; continuous 24-h blood glucose monitoring before and throughout the treatment showed improvement in both hypoglycemia and hyperglycemia, and insulin receptor antibodies were negative. The patient died shortly thereafter, and an autopsy revealed islet hyperplasia. We herein report a case of type B insulin receptor dysregulation with islet hyperplasia. Repeated hypoglycemic attacks in the early mornings initially brought the patient to our hospital, and subsequent hyperglycemia and high insulin levels led to a confirmed diagnosis. Notably, insulin receptor antibodies were found to be negative after steroid therapy.
