AI Article Synopsis
- Insulin autoimmune syndrome (IAS) is marked by high insulin levels and the presence of anti-insulin antibodies, often linked to thiol-containing drugs; however, this case shows it can also be induced by the proton pump inhibitor, omeprazole.
- A 27-year-old Chinese male with the HLA-DRB1*0406 subtype experienced symptoms of IAS, including hypoglycemia, after taking omeprazole without using insulin, confirmed by tests showing elevated insulin but only minor changes in C-peptide levels.
- His symptoms resolved after stopping omeprazole and following dietary guidelines, demonstrating a need for awareness of IAS risk when prescribing proton pump inhibitors, which are widely used.
Article Abstract
Insulin autoimmune syndrome (IAS) is characterized by hyperinsulinemic hypoglycemia and elevated anti-insulin antibodies. While thiol-containing drugs commonly induce IAS, cases induced by proton pump inhibitors are rare. We report a case of IAS induced by omeprazole in a 27-year-old Chinese man with the HLA-DRB1*0406 subtype. This patient presented with Whipple's triad after taking omeprazole without concurrent insulin use. The mixed-meal tolerance test (MMTT) and insulin-C-peptide release tests revealed a rapid surge in insulin levels within one hour, with a non-significant increase in C-peptide and a significant rise in insulin after precipitation. Further examination revealed high-titer positive insulin autoantibodies, leading to a diagnosis of insulin autoimmune syndrome (IAS). Symptoms resolved upon discontinuation of omeprazole and adherence to dietary recommendations, with insulin autoantibody levels decreasing after a 6-month follow-up. This case highlights omeprazole's potential to induce IAS, underscoring the need for vigilance due to widespread use of proton pump inhibitor.
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| http://dx.doi.org/10.1016/j.diabres.2024.111906 | DOI Listing |
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