Journal List > Endocrinol Metab > v.26(4) > 1085918

Choi, Choi, Jeong, Choi, Shin, Kim, Eom, Lee, Kim, Park, and Lee: A Case of the Type B Insulin Resistance Syndrome with Chronic Hepatitis B

Abstract

Type B insulin resistance syndrome is rare autoimmune disease that is characterized by various abnormalities of glycemic homeostasis, from hyperglycemia caused by extreme insulin resistance to fasting hypoglycemia. It can combine with other autoimmune diseases, most commonly systemic lupus erythematosus. It usually occurs in women and accompanies acanthosis nigricans, hyperandrogenism, and, in many cases, ovary dysfunction. The diagnosis of type B insulin resistance syndrome is based largely on the presence of insulin receptor autoantibodies and hyperglycemia, or hypoglycemia and hyperinsulinemia. In some cases, patients with the type B insulin resistance have been successfully treated with immunosuppressive therapy and plasmapheresis. We experienced type B insulin resistance syndrome in a patient with chronic hepatitis B and used only plasmapheresis for treatment. The immunosuppressive therapy was omitted due to the state of activation of chronic hepatitis B. We present this case with a review of relevant literature.

Figures and Tables

Fig. 1
Serum glucose change during plasmapheresis. X axis indicates days, we started plasmapheresis on day 1 and performed plasmapheresis nine times more during 2 weeks. Square spots is the day that plasmapheresis was done. Y axis indicates serum glucose level (mg/dL). After first and eighth plasmpheresis, rapid decrease of serum glucose level is showed. But hyperglycemia was developed subsequently. Eventually serum glucose was not controlled.
enm-26-360-g001

References

1. Kahn CR, Flier JS, Bar RS, Archer JA, Gorden P, Martin MM, Roth J. The syndromes of insulin resistance and acanthosis nigricans. Insulin-receptor disorders in man. N Engl J Med. 1976. 294:739–745.
2. Kim HS, Chung CH, Shin YG, Lee MD, Won YJ. Clinical characteristics in Korean patients with insulin receptor antibody positive acanthosis nigricans. J Korean Soc Endocrinol. 1998. 13:410–416.
3. Kawashiri SY, Kawakami A, Fujikawa K, Iwamoto N, Aramaki T, Tamai M, Nakamura H, Origuchi T, Ida H, Eguchi K. Type B insulin resistance complicated with systemic lupus erythematosus. Intern Med. 2010. 49:487–490.
4. Lee HC, Chung CH, Ahn KJ, Kim MR, Lim SK, Kim KR, Huh KB. A case of type A insulin resistance. Korean J Intern Med. 1992. 42:851–856.
5. Eriksson JW, Bremell T, Eliasson B, Fowelin J, Fredriksson L, Yu ZW. Successful treatment with plasmapheresis, cyclophosphamide, and cyclosporin A in type B syndrome of insulin resistance. Case report. Diabetes Care. 1998. 21:1217–1220.
6. Daniel AL, Houlihan JL, Blum JS, Walsh JP. Type B insulin resistance developing during interferon-alpha therapy. Endocr Pract. 2009. 15:153–157.
7. Arioglu E, Andewelt A, Diabo C, Bell M, Taylor SI, Gorden P. Clinical course of the syndrome of autoantibodies to the insulin receptor (type B insulin resistance): a 28-year perspective. Medicine (Baltimore). 2002. 81:87–100.
8. Chon S, Choi MC, Lee YJ, Hwang YC, Jeong IK, Oh S, Ahn KJ, Chung HY, Woo JT, Kim SW, Kim JW, Kim YS. Autoimmune hypoglycemia in a patient with characterization of insulin receptor autoantibodies. Diabetes Metab J. 2011. 35:80–85.
9. Joung KH, Kim HJ, Ku BJ. Type B insulin resistance syndrome with diabetic ketoacidosis. 2011. Acta Diabetol;In press.
10. Gehi A, Webb A, Nolte M, Davis J Jr. Treatment of systemic lupus erythematosus-associated type B insulin resistance syndrome with cyclophosphamide and mycophenolate mofetil. Arthritis Rheum. 2003. 48:1067–1070.
11. Lupsa BC, Chong AY, Cochran EK, Soos MA, Semple RK, Gorden P. Autoimmune forms of hypoglycemia. Medicine (Baltimore). 2009. 88:141–153.
12. Virally ML, Timsit J, Chanson P, Warnet A, Guillausseau PJ. Insulin autoimmune syndrome: a rare cause of hypoglycaemia not to be overlooked. Diabetes Metab. 1999. 25:429–431.
TOOLS
Similar articles