Endocrine Abstracts

We present a 32-year-old woman with recurrent hypoglycaemic episodes and a history of juvenile onset SLE. Over months, she experienced severe hypoglycaemic episodes with unconsciousness, occuring mainly in the early morning resulting in several hospital admissions. The patient had to take precautions like eating snacks between meals and before going to bed, and even setting an alarm clock to eat a bowl of porridge at 0200 h. She was of normal weight, did not present with any h...

Spontaneous hyperadrenocorticism in dogs and cats is most commonly (∼90%) caused by a functional pituitary tumour. As pituitary surgery is still an uncommon practice in veterinary science, these animals are generally managed medically using either mitotane or trilostane.The traditional method of managing PDH in dogs has been long term mitotane (o, pDDD) administration. The essence of this regime is to destroy most of the hyperplastic adrenal cortex...

A 65 year-old male was evaluated at another hospital for frequent episodes of fainting preceded by sweating, palpitations fatigue and hunger over several years. There was no personal or family history of diabetes mellitus. Hypoglycaemia was confirmed on a supervised fast and, guided by some equivocal uptake on a dotatate scan, he underwent a distal pancreatectomy, but the symptoms persisted. He was referred to our centre. He reported relentless weight gain and a need to eat po...

Autoimmune immunoglobulins directed against peptide hormones are well-described. These are often clinically benign, but may cause a deleterious effect on the accuracy of clinical immunoassays. A notable exception is Insulin Autoimmune Syndrome (IAS, also known as Hirata disease), where antibody-binding has a direct effect on insulin kinetics resulting in aberrant glucose control. Current methods to diagnose IAS rely on crude immune-subtraction techniques such as polyethylene g...

IAS is a very rare condition in which anti-insulin antibodies carry high concentrations of insulin in suspension in circulation. Hypoglycaemia occurs when insulin is released from the antibodies during fasting or post-prandially.We present two cases. Patient-A is a 52-year old Thai obese female, with acanthosis nigricans and a strong family history of T2DM. Patient-B is a 28 year-old normal- BMI Caucasian female with an unremarkable history. None of the ...

Insulin Autoimmune Syndrome (IAS)/Hirata disease is a very rare condition in which anti-insulin antibodies result in accumulation of high circulating concentrations of insulin in complexes. Hypoglycaemia in IAS occurs when insulin is released from the antibodies during fasting. We present two contrasting cases of Hirata disease. Both patients presented with symptomatic hypoglycaemia. Patient-A is a 52-year old obese Thai female, with acanthosis nigricans and a strong family hi...

Introduction: Immune mediated cases of severe insulin resistant diabetes are very rare. We report responses to immunosuppression with rituximab in two patients.Case 1: A 31 year old black African female, BMI 22.84 kg/m², was referred with new onset diabetes, diagnosed shortly following a miscarriage. She had weight loss, acanthosis nigricans, nocturnal hypoglycaemia and severe hyperandrogenism . She was on an insulin pump and required >1000 units in...

Introduction: Insulin autoimmune syndrome or Hirata disease is a rare cause of hypoglycemia without prior insulin exposure. Approximately 400 cases were reported, mostly in Japan. It’s associated with other autoimmune diseases or exposure to sulfhydryl-containing drugs.Case report: A 56-year-old Caucasian woman presented with a 20-month history of hypoglycemia ameliorated by sugar intake. She had a past history of autoimmune thyroiditis, asthma and ...