Severe hypoglycemia due to insulin auto-antibodies of newly diagnosed multiple myeloma: A case report

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dc.contributor.authorGuney S.C.
dc.contributor.authorMiskioglu M.
dc.contributor.authorEngurulu S.F.
dc.contributor.authorCavdar G.G.
dc.contributor.authorAkcura C.
dc.contributor.authorAlkan S.
dc.contributor.authorOzdemir N.
dc.contributor.authorHekimsoy Z.
dc.date.accessioned2024-07-22T08:01:28Z
dc.date.available2024-07-22T08:01:28Z
dc.date.issued2024
dc.description.abstractObjective: Insulin autoimmune syndrome (IAS) is a rare condition that can be overlooked in the differential diagnosis of hypoglycemia. Hematologic malignancies such as multiple myeloma (MM) have been associated with IAS. Very few cases of IAS due to multiple myeloma have been reported in the literature. We wanted to present our case who applied to our clinic with severe hypoglycemia and was diagnosed with multiple myeloma-associated IAS. Case presentation: An 83-year-old male patient was admitted to our clinic with recurrent severe hypoglycemia episodes. When the patient’s plasma glucose was 37 mg/dL, insulin level was high (2266 µIU/ml), C-peptide level was relatively normal (3.44 ng/ml); cortisol and ACTH levels were also normal. No pathologic finding was detected in the abdominal MRI and Ga-68 PET/CT. Anti-insulin antibody (IAA) was tested for IAS, and the antibody level was found to be 95.9%. The patient was evaluated in terms of possible conditions that may lead to IAS. Hematology consultation was made due to the fact that the patient had anemia, chronic renal failure, and albumin/globuline discordance, and he was diagnosed with IgG kappa multiple myeloma. Bortezomib and dexamethasone treatment was initiated. A decrease in hypoglycemic symptoms was observed with chemotherapy. Conclusion: IAS should be considered in the differential diagnosis of recurrent hypoglycemia cases of unknown cause. It should be kept in mind that IAS may develop due to multiple myeloma, especially in patients with advanced age and anemia. © The Author(s), under exclusive licence to Research Society for Study of Diabetes in India 2023.
dc.identifier.DOI-ID10.1007/s13410-023-01263-8
dc.identifier.issn09733930
dc.identifier.urihttp://akademikarsiv.cbu.edu.tr:4000/handle/123456789/11466
dc.language.isoEnglish
dc.publisherSpringer
dc.subjectalanine aminotransferase
dc.subjectalbumin
dc.subjectaspartate aminotransferase
dc.subjectbortezomib
dc.subjectC peptide
dc.subjectcorticotropin
dc.subjectcreatinine
dc.subjectdexamethasone
dc.subjectgallium 68
dc.subjectglobulin
dc.subjectglucose
dc.subjectgrowth hormone
dc.subjecthemoglobin
dc.subjecthemoglobin A1c
dc.subjecthydrocortisone
dc.subjectimmunoglobulin kappa chain
dc.subjectinsulin
dc.subjectinsulin antibody
dc.subjectlactate dehydrogenase
dc.subjectlenalidomide
dc.subjectthyrotropin
dc.subjecturea
dc.subjectaged
dc.subjectanemia
dc.subjectArticle
dc.subjectbone marrow aspiration
dc.subjectbone marrow biopsy
dc.subjectcancer chemotherapy
dc.subjectcase report
dc.subjectchronic kidney failure
dc.subjectclinical article
dc.subjectclinical evaluation
dc.subjectconsultation
dc.subjectcytopenia
dc.subjectdisease association
dc.subjectdisease severity
dc.subjectdyspnea
dc.subjectemergency health service
dc.subjectendocrinology
dc.subjectgastrointestinal motility disorder
dc.subjectglucose blood level
dc.subjecthematology
dc.subjecthospital admission
dc.subjecthuman
dc.subjecthypertension
dc.subjecthypoglycemia
dc.subjectinsulin autoimmune syndrome
dc.subjectinsulin level
dc.subjectinsulin treatment
dc.subjectinsulinoma
dc.subjectlaboratory test
dc.subjectmale
dc.subjectmedical history
dc.subjectmultiple myeloma
dc.subjectneuropathy
dc.subjectnon insulin dependent diabetes mellitus
dc.subjectnuclear magnetic resonance imaging
dc.subjectpallor
dc.subjectphysical disease by body function
dc.subjectphysical examination
dc.subjectpositron emission tomography-computed tomography
dc.subjectrecurrent disease
dc.subjectsecond-line treatment
dc.subjectsymptom
dc.subjecttreatment response
dc.subjecttreatment switching
dc.subjectvery elderly
dc.titleSevere hypoglycemia due to insulin auto-antibodies of newly diagnosed multiple myeloma: A case report
dc.typeArticle

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