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Endocrine Abstracts (2018) 59 MTE3.1 | DOI: 10.1530/endoabs.59.MTE3.1

Cambridge University Hospitals Trust, Cambridge, UK.


Quantitation of insulin in human plasma was first achieved by Berson and Yallow in 1960, as reported in their seminal paper describing radio-immunoassay (J Clin Invest. 1960(7)39:1157). Despite the wider availability of insulin assays, improvements in immunoassay design and the advent of mass-spectrometric methods to quantitate insulin, insulin assays are used far less than other hormone assays in endocrinological investigations. This is largely due to the dynamic nature of insulin in vivo and the complex relation between insulin concentration and relevant clinical correlates. The investigation of hypoglycaemia is the most widely accepted application for insulin assay. The endocrinologist needs to be vigilant when interpreting insulin concentration in this context as most commercial assays do not detect all synthetic insulins or biologically active but partially processed insulin such as proinsulin. Some assays do not have the required analytical sensitivity to measure insulin at low concentration. Mass-Spectrometric assays offer the promise for better detection of insulin analogues, but these are not yet widely available. Whilst useful in a research context, insulin assays are not routinely used to diagnose insulin resistance due to limited clinical utility. A notable exception is the diagnosis of severe insulin resistance syndromes where features like lipodystrophy are present or characteristics of insulin resistance are either extreme or disproportionate to habitus. Hirata syndrome is a rare condition caused by insulin autoantibodies; such antibodies can confound both the measurement of biologically active insulin and the diagnosis of hypoglycaemia. Patients usually present with very high plasma insulin. The situation becomes more complex when anti-insulin antibodies coexist with diabetes. Whilst anti-insulin antibodies are often detected in diabetes, in rare cases both insulin pharmacokinetics and our ability to detect biologically active insulin are affected.

Volume 59

Society for Endocrinology BES 2018

Glasgow, UK
19 Nov 2018 - 21 Nov 2018

Society for Endocrinology 

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