A Case of Insulin Autoimmune Syndrome Treated with Methylprednisolone Pulse Therapy after a Period of 10 years' of Observation

Abstract

A 39-year-old woman was diagnosed with insulin autoimmune syndrome (IAS) based on hypoglycemia, increased ¹²⁵I-insulin binding (51%), a TIRI of 720 μU/ml, a FIRI of 130μU and CPR at 4.2ng/ml in 1977. We observed the patient for 10 years since IAS was known to remit spontaneously. However, she gained 13 kg of body weight and became hypertensive during this period. Fasting CPR was elevated to 11.5ng/ml and hypoglycemic attacks became more frequent in 1994. We treated twice with 1000 mg a day of methylprednisolone. Following this fasting CPR fell to 2.4ng/ml and was associated with a fall in ¹²⁵I-insulin binding to 10%. She became asymptomatic. Steroid pulse therapy may effectively suppress insulin antibody formation in IAS, resulting in reduction of body weight and blood pressure.