Endocrine Abstracts

Background: Insulin Antibody Syndrome (IAS), is a rare autoimmune condition characterized by spontaneous hypoglycemia due to high titres of insulin autoantibodies in individuals who have not been previously exposed to exogenous insulin.The pathophysiology involves the formation of autoantibodies that bind circulating insulin, creating a large insulin-antibody complex. This binding alters insulin kinetics, leading to delayed insulin release and unpredictable fluctuations in glucose levels.

Case Description: We present the case of a 25-year-old female who was admitted with recurrent symptomatic hypoglycemia in the absence of diabetes or insulin therapy.

Clinical Hypothesis: The pathophysiology involves the formation of autoantibodies that bind circulating insulin, creating a large insulin-antibody complex. This binding alters insulin kinetics, leading to delayed insulin release and unpredictable fluctuations in glucose levels. Clinically, patients may present with recurrent episodes of hypoglycemia, which can range from mild adrenergic symptoms to severe neuroglycopenic events, particularly in the postprandial state.

Diagnostic Pathway: Flash glucose monitoring confirmed reactive hypoglycaemia and insulin antibodies were positive, C peptide was within reference range. Her symptoms eased with frequent, small meals and to avoid simple sugars.

Discussion and Learning Points: Insulin Antibody Syndrome, should be considered in the differential diagnosis of spontaneous hypoglycemia, in non-diabetic individuals with no history of exogenous insulin use. This case highlights the diagnostic challenge of paradoxical laboratory findings of hyperinsulinemia and hypoglycemia in the absence of insulin administration. Early recognition and appropriate immunological testing are crucial to avoid misdiagnosis and unnecessary interventions. In our patient, timely identification of insulin autoantibodies guided a conservative, non-invasive treatment approach, leading to clinical improvement and resolution of hypoglycemic episodes.