Imaging of the buffering effect of insulin antibodies in the autoimmune hypoglycemic syndrome

Nicoletta Dozio, Marina Scavini, Angelo Beretta, Elena Sarugeri, Stefano Sartori, Cristina Belloni, Flaviano Dosio, Annarita Savi, Ferruccio Fazio, Jean Claude Sodoyez, Guido Pozza

Research output: Contribution to journalArticle

Abstract

Insulin autoimmune hypoglycemia is characterized by recurrent hypoglycemia and high levels of immunoreactive insulin in the presence of insulin autoantibodies. The mechanisms inducing hypoglycemia are largely unknown. An [123I]insulin scintigraphic scanning was performed to directly demonstrate the effect of antibodies on insulin biodistribution in one patient with this syndrome both before and after treatment. The patient had insulin autoantibodies IgG3 λ, which had a single site dissociation constant (K(d) = 10-7 mol/L, by Scatchard analysis), a very fast dissociation rate of immune complexes, and a very rapid association of [125I]insulin. Insulin receptors on red blood cells were down-regulated. The [123I]insulin scintigraphic study imaged the buffering effect of antibodies on insulin bioavailability. [123I]Insulin was not removed from the blood, and no liver or kidney uptake of the hormone occurred. The frequency and severity of hypoglycemic episodes required treatment. Insulin antibody levels decreased and [123I]insulin biodistribution improved after treatment with plasmapheresis and prednisone. Improved hormone bioavailability was further evidenced by the reduction in the hypoglycemic delay after iv insulin from 90 min before any treatment to 60 min after plasmapheresis and 30 min after steroid administration. Glucose tolerance was normal after treatment. Plasmapheresis followed by steroid treatment can lower the insulin antibody concentration, abolish severe hypoglycemia, and improve insulin biodistribution and glucose tolerance in insulin autoimmune hypoglycemia.

Original languageEnglish
Pages (from-to)643-648
Number of pages6
JournalJournal of Clinical Endocrinology and Metabolism
Volume83
Issue number2
DOIs
Publication statusPublished - 1998

Fingerprint

Insulin Antibodies
Hypoglycemic Agents
Insulin
Imaging techniques
Hypoglycemia
Plasmapheresis
Autoantibodies
Biological Availability
Therapeutics
Steroids
Hormones
Blood
Glucose
Insulin Receptor
Prednisone
Antigen-Antibody Complex
Antibodies
Liver

ASJC Scopus subject areas

  • Biochemistry
  • Endocrinology, Diabetes and Metabolism

Cite this

Imaging of the buffering effect of insulin antibodies in the autoimmune hypoglycemic syndrome. / Dozio, Nicoletta; Scavini, Marina; Beretta, Angelo; Sarugeri, Elena; Sartori, Stefano; Belloni, Cristina; Dosio, Flaviano; Savi, Annarita; Fazio, Ferruccio; Sodoyez, Jean Claude; Pozza, Guido.

In: Journal of Clinical Endocrinology and Metabolism, Vol. 83, No. 2, 1998, p. 643-648.

Research output: Contribution to journalArticle

Dozio, N, Scavini, M, Beretta, A, Sarugeri, E, Sartori, S, Belloni, C, Dosio, F, Savi, A, Fazio, F, Sodoyez, JC & Pozza, G 1998, 'Imaging of the buffering effect of insulin antibodies in the autoimmune hypoglycemic syndrome', Journal of Clinical Endocrinology and Metabolism, vol. 83, no. 2, pp. 643-648. https://doi.org/10.1210/jc.83.2.643
Dozio, Nicoletta ; Scavini, Marina ; Beretta, Angelo ; Sarugeri, Elena ; Sartori, Stefano ; Belloni, Cristina ; Dosio, Flaviano ; Savi, Annarita ; Fazio, Ferruccio ; Sodoyez, Jean Claude ; Pozza, Guido. / Imaging of the buffering effect of insulin antibodies in the autoimmune hypoglycemic syndrome. In: Journal of Clinical Endocrinology and Metabolism. 1998 ; Vol. 83, No. 2. pp. 643-648.
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