Diagnosis and Treatment > Investigation > Protein electrophoresis
You are looking at 1 - 5 of 5 items
Search for other papers by Marina Yukina in
Google Scholar
PubMed
Search for other papers by Nurana Nuralieva in
Google Scholar
PubMed
Search for other papers by Maksim Solovyev in
Google Scholar
PubMed
Russian Academy of Sciences, Endocrinology Service, Department of Therapeutic Endocrinology, Endocrinology Research Centre (ERC), Moscow, Russia
Search for other papers by Ekaterina Troshina in
Google Scholar
PubMed
Search for other papers by Evgeny Vasilyev in
Google Scholar
PubMed
Summary
Insulin autoimmune syndrome (Hirata’s disease) is a disorder caused by development of autoantibodies to insulin and manifested by hypoglycaemic syndrome. The overwhelming majority of physicians do not include it in the differential diagnosis of hypoglycaemic states because of a misconception of an extremely low prevalence of this condition. This results in unnecessary drug therapy and unjustified surgical interventions in patients that otherwise would be successfully treated conservatively. This disease is strongly associated with certain alleles of the HLA gene. In most cases, this condition develops in predisposed individuals taking drugs containing sulfhydryl groups. Formation of autoantibodies to insulin may be observed in patients with other autoimmune disorders, as well as in those with multiple myeloma or monoclonal gammopathy of undetermined significance. This paper presents the first Russian case report of insulin autoimmune syndrome in an adult patient.
Learning points:
-
Insulin autoimmune syndrome, Hirata’s disease, anti-insulin antibodies, and hypoglycaemia.
Search for other papers by Sulaiman Haji Ali in
Google Scholar
PubMed
Search for other papers by K Aljenaee in
Google Scholar
PubMed
Search for other papers by W A Wan Mahmood in
Google Scholar
PubMed
University College Dublin, Dublin, Ireland
Search for other papers by M Hatunic in
Google Scholar
PubMed
Summary
Hypothyroidism is a recognized side effect of thalidomide drugs. We herein report a case of 83-year-old Irish female with a diagnosis of multiple myeloma and a background history of type 2 diabetes mellitus and hypertension. Our patient received pomalidomide and multiple courses of chemotherapy and achieved very good initial response for her multiple myeloma but subsequently she relapsed. She did not have any past history of thyroid disease or family history of thyroid disorders. Prior to treatment with pomalidomide, her thyroid function test was completely normal. She was commenced on pomalidomide in February 2017. Four weeks post treatment, she presented with worsening fatigue, and as a part of her workup, a thyroid function test was performed. Her free T4 was low at 7.2 pmol/L (reference range: 9.0–20.0) while her TSH was elevated at 44.7 mIU/L (reference range: 0.35–4.94). Pomalidomide treatment was terminated, and she was commenced on thyroid hormonal therapy replacement therapy with thyroxine with good clinical and biochemical response. Practitioners prescribing pomalidomide should be aware of this potential complication and patients who are receiving immunomodulatory drugs like pomalidomide should undergo regular thyroid hormone levels screen.
Learning points:
-
Overt hypothyroidism is a side effect of pomalidomide.
-
Thyroid function test should be included as a screening test with regular review in patients receiving pomalidomide.
-
Unexplained worsening fatigue in patients receiving pomalidomide should raise the possibility of overt hypothyroidism.
Search for other papers by Milena S Pandrc in
Google Scholar
PubMed
Search for other papers by Stanko Petrović in
Google Scholar
PubMed
Search for other papers by Vanja Kostovski in
Google Scholar
PubMed
Search for other papers by Marijana Petrović in
Google Scholar
PubMed
Search for other papers by Miloš Zarić in
Google Scholar
PubMed
Summary
Immunoglobulin (Ig)G4-related sclerosing disease (IgG4-RSD) is a new disease entity first proposed with regard to autoimmune pancreatitis. A 67-year-old male patient was examined because of weight loss and an abdominal pain. Based on the clinical characteristics, laboratory parameters and ultrasound features, we identified the diagnosis of the IgG4-related systemic disease (IgG4-RSD), that was confirmed by the histopathological analysis after the biopsy of the head of pancreas. After confirmation, we started with the corticosteroid therapy with a good clinical, biochemical and morphological response. During the previous therapy, the disturbance of glucoregulation appeared, so we had to change the modality of treatment. We decided to add Azathioprine to the therapy in a dose of 150 mg/day. We achieved a stable phase of the disease with IgG 4.37 g/l and IgG4 0.179 g/l, and with no side effects from the therapy.
Learning points
-
There are potential clinical applications of identifying subsets of patients with IgG4 thyroiditis (FVHT and Riedel thyroiditis).
-
A trial of immunosuppressive therapy should be included if a resection is deemed inadvisable.
-
In particular, cases of FVHT that mimic malignancy, tissue and serum IgG4 may provide supportive diagnostic information.
Search for other papers by Mahmud Abo Salook in
Google Scholar
PubMed
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Search for other papers by Carlos Benbassat in
Google Scholar
PubMed
Search for other papers by Yulia Strenov in
Google Scholar
PubMed
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Search for other papers by Amit Tirosh in
Google Scholar
PubMed
Summary
A 55-year-old male, with a positive medical history for hypothyroidism, treated with stable doses for years was admitted with subacute thyroiditis and a feeling of pain and pressure in the neck. Laboratory tests showed decrease in TSH levels, elevated erythrocyte sedimentation rate, and very high antithyroid antibodies. Owing to enlarging goiter and exacerbation in the patient's complaints, he was operated with excision of a fibrotic and enlarged thyroid lobe. Elevated IgG4 plasma levels and high IgG4/IgG plasma cell ratio on immunohistochemistry led to the diagnosis of IgG4-mediated thyroiditis. We concluded that IgG4-thyroiditis and IgG4-related disease should be considered in all patients with an aggressive form of Hashimoto's thyroiditis.
Learning points
-
IgG4-related disease is a systemic disease that includes several syndromes; IgG4-related thyroiditis is one among them.
-
IgG4-thyroiditis should be considered in all patients with an aggressive form of Hashimoto's thyroiditis.
-
Patients with suspected IgG4-thyroiditis should have blood tested for IgG4/IgG ratio and appropriate immunohistochemical staining if possible.
Search for other papers by Kamel Mohammedi in
Google Scholar
PubMed
Search for other papers by Charbel Abi Khalil in
Google Scholar
PubMed
Search for other papers by Sophie Olivier in
Google Scholar
PubMed
Search for other papers by Imane Benabad in
Google Scholar
PubMed
Search for other papers by Ronan Roussel in
Google Scholar
PubMed
Search for other papers by Michel Marre in
Google Scholar
PubMed
Summary
Hypoglycemia is a common medical emergency. It is the most frequent complication induced by anti-diabetic treatment. However, it can be observed in other conditions unrelated to diabetes such as insulinoma, autoimmune disorders, and neoplasia. Herein, we report the case of a rare cause of severe and recurrent hypoglycemia in a 77-year-old woman with a malignant solitary fibrous tumor (MSFT). A 77-year-old woman was admitted to the emergency department for loss of consciousness induced by severe hypoglycemia. Her standard laboratory findings were unremarkable. HbA1c, albumin, renal, liver, thyroid, and adrenal function tests were normal. Cerebral CT scan was also normal. At the time of confirmed hypoglycemia, the serum level of insulin and C-peptide was low. On the basis of the past medical history and the absence of other comment etiologies, a paraneoplastic cause was suspected. Thus, the diagnosis of a non-islet cell tumor-induced hypoglycemia (NICTH) was established by the presence of incompletely processed precursors of IGF2 (big IGF2) in plasma electrophoresis. However, the IGF1 level was low. Therapy with corticosteroids improved hypoglycemia and clinical symptoms. NICTH is a rare cause of hypoglycemia. It should be considered in patients with mesenchymal or malignant epithelial tumors suffering from recurrent episodes of hypoglycemia. The diagnosis will be established in the case of low serum insulin concentrations and elevated levels of big IGF2. Treatment with corticosteroids, GH, or both can improve hypoglycemic symptoms and restore plasma glucose to normal levels.
Learning points
-
NICTH is a very rare condition that should be considered in patients known to have mesenchymal or malignant epithelial tumors and suffering from recurrent episodes of hypoglycemia.
-
The diagnosis of an NICTH is established on the basis of the hypoinsulinemic hypoglycemia, the MSFT history, and the presence of paraneoplastic secretion of IGF1 or an immature form of IGF2.
-
Treatment with corticosteroids, GH, or both can improve hypoglycemic symptoms and restore plasma glucose to normal levels in NICTH.
