甲巯咪唑致胰岛素自身免疫综合征二例并文献复习

Insulin autoimmune syndrome induced by methimazole:two-case report and literature review

目的探讨因服用甲巯咪唑治疗甲亢导致胰岛素自身免疫综合征(IAS)患者的临床特点。方法回顾分析我院2例确诊为IAS患者的临床资料,并复习相关文献。结果2例患者均在确诊甲亢后给予甲巯咪唑治疗,分别于用药10d、30d后出现乏力及神志障碍,血糖低,诊断为低血糖症,进一步检测结果显示,胰岛素水平明显升高、抗胰岛素抗体(IAA)阳性,诊断为IAS。停用甲巯咪唑,给予多次进餐及糖皮质激素处理后症状缓解,血糖恢复正常,并选择131I治疗甲亢,病情控制良好。结论甲亢患者服用甲巯咪唑治疗后出现反复低血糖发作,应考虑IAS,及时行血糖、胰岛素测定及胰岛素抗体检测以明确诊断,以免造成误诊及严重后果的发生。

Objective To investigate the clinical characteristics of insulin autoimmune syndrome( IAS) patients with hyperthyroidism treated with methimazole. Methods The clinical data of two patients with IAS diagnosed in our hospital were retrospectively analyzed, and the related literature was reviewed. Results Both patients were treated with methimazole after the diagnosis of hyperthyroidism. After 10 days and 30 days of treatment,f atigue and mental disorders occurred, and they were diagnosed with hypoglycemia. The level of insulin was significantly elevated, anti-insulin antibody( IAA) was positive, and IAS was confirmed. Methimazole was discontinued. After treatment with diet and glucocorticoid, the symptoms were relieved and blood sugar returned to normal. 131 I was selected to treat hyperthyroidism, and the condition was well controlled. Conclusion IAS should be considered for repeated hypoglycemic episodes in patients with hyperthyroidism after taking methimazole. Blood sugar, insulin and insulin antibody should be measured in time to make a definite diagnosis, so as to avoid misdiagnosis and serious consequences.