インスリン自己免疫を示したバセドウ病の12例
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In 1970, Hirata et al. first described a case of spontaneous hypoglycemia resulting from autoimmune insulin-binding antibodies in the serum.<BR>Until the Hirata report, it was generally accepted that insulin-binding antibodies were not been found in patients not treated with insulin.<BR>In fact, it was extremely rare to detect insulin-binding antibodies in patients who had not received insulin injections. Nevertheless, we recently demonstrated insulin-binding antibodies for endogenous insulin in twelve patients with Graves' disease. None of them had diabetes mellitus, but the following 2 cases had suffered from hypoglycemic attacks<BR>Case 1 E.T., a 23-year-old woman was admitted to the Noguchi Thyroid Clinic, on February 8, 1971, because of Graves' disease. In the early morning of March 1, the next day and three days later, she was found to have lost consciousness due to decreased venous glucose levels which ranged from 26 mg/dl to 36 mg/dl. Serum insulin levels after an ex-traction procedure with acid ethanol were extremely increased and ranged from 23,100/μU/ ml to 35,280/μU/ml during hypoglycemic attacks. Although she had never received an insulin injection, titers of insulin-binding antibodies determined as <SUP>125</SUP>I-insulin-binding percent were from 70.5% to 82.5% in her sera. She had a subtotal thyroidectomy for Graves' disease on March 9. Two years after operation, insulin-binding antibodies were still detected in her sera, though <SUP>125</SUP>I-insulin-binding percent and serum insulin levels gradually decreased since the hypoglycemic attacks.<BR>Case 2 Y.T., a 30-year-old woman, was given thiamazole for Graves' disease for three weeks. From February 20 to 28, 1970, drowsiness and pain in the extremities developed. At that time, levels of fasting blood glucose ranged from 41 mg/dl to 44 mg/dl, but neither insulin nor blood glucose levels after glucose administration were estimated. 4.0 mCi of radioiodine (<SUP>131</SUP>I) for Graves' disease was administered on March 14, 1970. Two years later due to hypoglycemic attacks, insulin-binding antibodies were demonstrated in her sera, although she did not receive insulin injections. The fasting blood glucose was normal as 99 mg/dl, but the glucose tolerance curve showed a diabetic pattern. The fasting insulin level was estimated at 130 μU/dl after the extraction procedure using acid ethanol. These results suggest that hypoglycemic attacks which occurred two years previously, were also due to the production of insulin-binding antibodies for endogenous insulin.<BR>In the sera of the remaining ten patients with Graves' disease not accompanied by hypoglycemia and who had never received insulin injections, insulin-binding antibodies were demonstrated. That is, 2.3% of Graves' disease patients had insulin-binding anti-bodies for endogenous insulin. In these cases, fasting blood glucose levels were within normal range, but fasting serum insulin increased and was estimated to be from 50 μU/ ml to 850 μU/ml. Glucose tolerance curves showed abnormal patterns, such as diabetic or oxyhyperglycemic patterns.<BR>As serum insulin levels increased after oral glucose administration, <SUP>125</SUP>-insulin-binding percent decreased in all six patients who were examined by glucose tolerance test.<BR>It is interesting that all twelve of the patients were given thiamazole for Graves' dis-ease and demonstrated autoimmune insulin-binding antibodies. In three of these patient, insulin-binding antibodies were not detected before administration of thiamazole. From four to eight weeks after cessation of thiamazole administration, insulin-binding antibodies were decreased in the sera of five patients and were not detected in three patients.