INSULIN AUTOIMMUNE SYNDROME AS A CAUSE OF SPONTANEOUS HYPOGLYCEMIA INALCOHOLIC CIRRHOSIS

Hypoglycemia in fulminant hepatic failure and hyperinsulinemia in cirr hosis are well-described phenomena, A patient with alcoholic cirrhosis who developed fasting hypoglycemia with an extremely high immunoreact ive insulin level and a mildly elevated C-peptide level is reported, A n insulinoma was excluded by detailed radiological imaging of the panc reas and by endoscopic ultrasonography, Detection of very high levels of insulin autoantibodies with no prior exposure to exogenous insulin confirmed the diagnosis of insulin autoimmune syndrome, During his hos pital course, the patient developed another rave syndrome, acquired in hibitors to factor V, which led to the fatal coagulopathy that resulte d in his death, Insulin autoimmune syndrome is the third leading cause of spontaneous hypoglycemia in Japan, where it has been associated wi th a variety of diseases and drugs, Outside of Japan, only approximate ly 20 cases have been reported and usually have been found in the cont ext of an underlying autoimmune disorder or prior exposure to sulfhydr yl drugs, It is believed that this is the first case reported outside Japan occurring in association with alcoholic liver disease, and the f irst in the would with coexisting acquired inhibitors to factor V.