甲巯咪唑致胰岛素自身免疫综合征一例并文献复习

A Case of Methimazole-Induced Insulin Autoimmune Syndrome and Literature Review

随访一例因使用甲巯咪唑诱发胰岛素自身免疫综合征(IAS)的患者,分析患者临床资料及诊治过程,并对相关文献进行复习。患者服用甲巯咪唑4月后反复出现“心悸、乏力、大汗”等表现,伴有烦躁、易激动等焦虑情绪,多次就诊于我院急诊科,发作时血糖最低3.0 mmol/L,进食或补充葡萄糖后症状好转,持续葡萄糖监测示有反复低血糖发生。实验室检查示血清胰岛素自身抗体(IAA)阳性,确诊为IAS。入院后停用甲巯咪唑,改为丙硫氧嘧啶,调整饮食结构,予泼泥松30 mg/d,低血糖发作逐渐缓解。随访2个月,未再发生低血糖症状,血清IAA水平明显降低。IAS是发生反复低血糖的病因之一,可由服用含羟基药物诱发,以甲巯咪唑最为常见。IAA检测为诊断该病的主要依据,经治疗预后良好。A patient with methimazole-induced insulin autoimmune syndrome (IAS) was followed up with the analysis of his clinical data, diagnosis and treatment process, and a literature review was performed. After taking methimazole for 4 months, the patient repeatedly had “palpitations, fatigue, sweating”, accompanied by irritability, irritability and other anxious emotions, and visited the emergency department of our hospital many times, and the blood glucose was as low as 3.0 mmol/L at the time of the attack, symptoms improve with food or glucose supplementation, and continuous glucose monitoring (CGM) showed repeated hypoglycemia. Laboratory tests show a positive serum insulin autoantibody (IAA) and confirm the diagnosis of IAS. After admission, methimazole was stopped, propylthiouracil was replaced, the dietary structure was adjusted, and pronisolone 30 mg/d was given, and the hypoglycemic attack was gradually relieved. After 2 months of follow-up, there were no more symptoms of hypoglycemia and serum IAA levels were significantly reduced. IAS is one of the causes of recurrent hypoglycemia and can be triggered by the use of hydroxyxyl-containing drugs, most commonly methimazole. IAA testing is the mainstay of diagnosis and has a good prognosis after treatment.