CASE REPORT

Anti-Insulin Antibody Syndrome Following Alpha-Lipoic Acid Use in Turkish Patients: Report of Three New Cases
Türk Hastalarda Alfa Lipoik Asit Kullanımına Sekonder Antiinsülin Antikoru Sendromu: Üç Yeni Vaka
Received Date : 05 Apr 2021
Accepted Date : 26 May 2021
Available Online : 07 Jun 2021
Doi: 10.25179/tjem.2021-83643 - Makale Dili: EN
Turk J Endocrinol Metab. 2021;25:337-343
Bu makale, CC BY-NC-SA altında lisanslanmış açık erişim bir makaledir.
ABSTRACT
Anti-insulin antibody syndrome is a rare autoimmune disorder that is characterized by severe hypoglycemia, elevated blood insulin level, insulin autoantibodies, and the absence of pancreas islet cell pathology or exogenous insulin exposure. Alpha-lipoic acid is a sulfhydrylcontaining compound that is used to treat diabetic peripheral neuropathy and was first reported as a cause of anti-insulin antibody syndrome in Japan in 2003. In the literature, 17 cases with anti-insulin antibody syndrome following alpha-lipoic acid use have been reported from Japan, along with one case from Turkey, two from Korea, and seven cases from Italy. In this article, we present three cases with anti-insulin antibody syndrome developed after alpha-lipoic acid use. Case 1: A 72-year-old male patient was observed to have lost consciousness at home. This patient had no history of diabetes mellitus, diabetic medication, or insulin use. The patient complained of tiredness, palpitations, and sweating that began 3-4 h after eating but regressed after eating during the past month. The patient had a history of diagnosis with lumbar disk hernia two months ago and was using alpha-lipoic acid (600 mg). Case 2: A 67-year-old diabetic female patient using alpha-lipoic acid (600 mg) following the diagnosis of diabetic peripheral neuropathy. She complained of shivering and sweating two to three hours after a meal that started after starting alpha-lipoic acid therapy. Case 3: A 46-year-old male patient complained of fatigue, palpitations, and sweating for the last three weeks. Seven weeks ago, he started using alpha-lipoic acid (600 mg) after being diagnosed with carpal tunnel syndrome. The patients were diagnosed with anti-insulin antibody syndrome secondary to alpha-lipoic acid use, following which their alpha-lipoic therapy was discontinued. Alpha-lipoic acid is widely used in the treatment of diabetic peripheral neuropathy, nutritional support, or as an anti-aging agent. However, it should be noted that its use may cause anti-insulin antibody syndrome in genetically predisposed people.
ÖZET
Antiinsülin antikor sendromu; şiddetli hipoglisemi, yüksek kan insülin seviyesi, insülin otoantikorlarının varlığı, pankreas adacık hücresi patolojisinin olmaması ve eksojen insüline maruziyeti yokluğu ile karakterize nadir görülen bir otoimmün hastalıktır. Alfa-lipoik asit diyabetik periferik nöropatiyi tedavi etmek için kullanılır ve ilk olarak 2003 yılında Japonya'da antiinsülin antikor sendromunun bir nedeni olarak bildirilen sülfhidril içeren bir bileşiktir. Literatürde, Japonya'dan alfalipoik asit kullanımına sekonder antiinsülin antikor sendromlu 17 olgu, Türkiye'den 1, Kore'den 2 ve İtalya'dan 7 olgu bildirilmiştir. Bu makalede, alfa-lipoik asit kullanımına ikincil gelişen antiinsülin antikor sendromlu 3 olguyu sunuyoruz. Olgu 1: Yetmiş iki yaşındaki erkek hastanın, evde bilincini kaybetmiş. Bu hastanın, diabetes mellitus, diyabetik ilaç veya insülin kullanımı öyküsü yoktur. Son 1 aydır yemekten 3-4 saat sonra başlayan ancak yemek yedikten sonra gerileyen yorgunluk, çarpıntı ve terleme şikâyeti vardır. Öyküsünde 2 ay önce bel fıtığı tanısı almış ve alfa-lipoik asit (600 mg) kullanıyordu. Hastaya antiinsülin antikor sendromu tanısı kondu ve alfa-lipoik asit tedavisi kesildi. Olgu 2: Altmış yedi yaşında diyabetik kadın hasta, diyabetik periferik nöropati tanısıyla alfa-lipoik asit (600 mg) kullanıyordu. Alfa-lipoik asit tedavisine başladıktan sonra başlayan yemekten 2-3 saat sonra titreme ve terleme şikâyetleri vardı. Olgu 3: Kırk altı yaşındaki erkek hastanın son 3 haftadır yorgunluk, çarpıntı ve terleme şikâyetleri mevcuttu. Yedi hafta önce karpal tünel sendromu tanısıyla alfa-lipoik asit (600 mg) kullanmaya başlamıştı. Hastalara alfa-lipoik asit kullanımına, sekonder antiinsülin antikor sendromu tanısı kondu ve alfa-lipoik tedavileri kesildi. Sonuç olarak, alfa-lipoik asit, diyabetik periferal nöropatinin tedavisinde, beslenme desteğinde veya yaşlanmayı geciktirici bir ajan olarak yaygın olarak kullanılmaktadır; ancak bunun genetik yatkınlığı olan kişilerde antiinsülin antikor sendromuna neden olabileceği unutulmamalıdır.
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