- مبلغ: ۸۶,۰۰۰ تومان
- مبلغ: ۹۱,۰۰۰ تومان
Objectives: Insulin autoimmune syndrome (IAS) or Hirata disease is a rare cause of autoimmune hypoglycemia with apparent high insulin levels and anti-insulin autoantibodies and was first described by Hirata in Japan in 1970. IAS cases are usually related to exposure to sulfhydryl-containing drugs, which stimulate the production of insulin autoantibodies. Among sulfhydryl-containing compounds, alpha lipoic acid (ALA) has recently emerged as a cause of IAS. After the first observations of ALA-induced IAS were reported in Japan in 2006, an increasing number of cases related to ALA administration have been described. An Italian group recently reported on six cases of IAS of which one was associated with HLA-DRB1*04:06 and the remaining five with HLA-DRB1*04:03. This suggests that the latter is potentially involved in the genetic susceptibility of people of European descent to IAS. Methods: Here, we describe two new cases of IAS in women that were triggered by ALA. Results: Both cases are associated with HLA-DRB1*04:03 and confirm the evidence that HLA-DRB1*04:03 rather than HLA-DRB1*04:06 is specifically related to IAS susceptibility in Europeans. Conclusions: Case reports of ALA-induced hypoglycemic episodes highlight the need for greater care in prescribing ALA supplementation as well as the identification of specific and personalized therapeutic targets.
It is interesting to note that ALA supplementation could exert a contrasting effect. While ALA is prescribed to potentiate the effect of insulin and reduce body weight, ALA also might determine an autoimmune syndrome and stimulate the production of circulating anti-insulin antibodies, which seem to limit the effect of endogenous insulin. Case reports of ALA-induced hypoglycemic episodes impose the need for greater care in prescribing ALA supplementation as well as the identification of specific and personalized therapeutic targets. Furthermore, when investigating differential diagnoses of hypoglycemia, physicians must be mindful of possible supplement self-prescription and consider IAS when more specific causes of hypoglycemia have been excluded.