Two Cases of Methimazole-Induced Insulin Autoimmune Syndrome in Graves’ Disease
노은, 김예안, 구유정, 배재현, 김혜미, 조영민, 박영주, 박경수, 김성연, 곽수헌,
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노은 ( Roh Eun )
Seoul National University College of Medicine Department of Internal Medicine
김예안 ( Kim Ye-An )
Seoul National University College of Medicine Department of Internal Medicine
구유정 ( Ku Eu-Jeong )
Seoul National University College of Medicine Department of Internal Medicine
배재현 ( Bae Jae-Hyun )
Seoul National University College of Medicine Department of Internal Medicine
김혜미 ( Kim Hye-Mi )
Seoul National University College of Medicine Department of Internal Medicine
조영민 ( Cho Young-Min )
Seoul National University College of Medicine Department of Internal Medicine
박영주 ( Park Young-Joo )
Seoul National University College of Medicine Department of Internal Medicine
박경수 ( Park Kyong-Soo )
Seoul National University College of Medicine Department of Internal Medicine
김성연 ( Kim Seong-Yeon )
Seoul National University College of Medicine Department of Internal Medicine
곽수헌 ( Kwak Soo-Heon )
Seoul National University College of Medicine Department of Internal Medicine
KMID : 0356620130280010055
Abstract
We report here the cases of two females with Graves’ disease who developed insulin autoimmune syndrome after treatment with methimazole. The patients exhibited a sudden altered mental state after treatment with methimazole for approximately 4 weeks. Patients had hypoglycemia with serum glucose below 70 mg/dL, and laboratory findings showed both high levels of serum insulin and high titers of insulin autoantibodies. The two women had never been exposed to insulin or oral antidiabetic agents, and there was no evidence of insulinoma in imaging studies. After glucose loading, serum glucose, and total insulin levels increased abnormally. One of the patient was found to have HLA-DRB1*0406, which is known to be strongly associated with methimazole-induced insulin autoimmune syndrome. After discontinuation of methimazole, hypoglycemic events disappeared within 1 month. Insulin autoantibody titer and insulin levels decreased within 5 months and there was no further development of hypoglycemic events. We present these cases with a review of the relevant literature.
키워드
Graves disease;Insulin autoimmune syndrome;Methimazole
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