A 65-year-old woman with a history of hypertension and depression treated with fluoxetine and loartan.
She had episodes of sweating, tremor, and headache that occurred predominantly postprandially late.
Having a new episode associated with impaired consciousness, she was admitted to the Emergency Department with blood glucose of 43 mg/dl and was hospitalized.
The consumption of other drugs and no family or personal history of diabetes mellitus existed.
Physical examination revealed a BMI of 29 kg/m2, with no acanthosis nigricans or other findings.
Normal thyroid hormones, HbA1c 6.4%, basal cortisol μg/ml, insulinemia10 μIU/ml (Roche IL), urinary peptide C 19.5 were the most important tests.
Fasting tests were performed without hypoglycemia, maintaining persistently high levels of insulin and C-peptides.
PTGO showed hyperinsulinemia and early hyperglycemia with subsequent hypoglycemia.
1.
Abdominal CT and MRI, pancreatic endosonography and 68Ga positron emission tomography (PET) were normal.
Anti-insulin antibodies were requested, which were positive.
We determined basal insulinemia and after precipitation with polylenglycol (PEG)3 which was 1,483 and 114 μUI/, respectively.
Sjögren's syndrome with positive Anti-Ro was also diagnosed.
Quantification of immunoglobulins and protein electrophoresis were normal.
HLA class II was determined by PCR using the Dynal Reli kit that allowed analyzing the groups DQ/DR resulting in HLA DQ2-DQ8 and HLA-DR3-DR4.
Subsequently, a high-resolution extended analysis was used for subtypes 0103 specific to subregions α and β of the HLA class II complex, detecting the following HLA-Q*D HLA-DQB1* 0201 - D
Treatment consisted of dieting with low glycemic index, presenting partial response.
Acarbose was added with good initial response, but for new episodes of hypoglycemia prednisone 30 mg/day was added.
At 2 months of treatment, basal insulinemia of 462 μUI/ml and post PEG 46 μUI/ml were measured.
During follow-up, symptoms and insulinemias progressively decreased, allowing discontinuation of pharmacological therapy.
Currently, the patient is asymptomatic, with no need for therapy and lower insulin levels.
