Clinical efficacy of insulin-like growth factor-1 in a patient with autoantibodies to insulin receptors: a case report

The type B insulin-resistance syndrome is characterized by the presence of anti-insulin receptor antibodies that cause severe insulin resistance. Trea tments including steroids, cyclophosphamide, plasmapheresis, or insulin-lik e growth factor-1 (IGF-I) are chosen according to severity of insulin resis tance. We describe a patient with type B insulin resistance syndrome who wa s treated successfully with human recombinant (hr) IGF-1, although this tre atment provoked a severe allergic reaction. An elderly man with impaired gl ucose tolerance and unpredictable hypoglycemic episodes which were graduall y worsening increased in hemoglobin (Hb)Alc concentration from 6.5 to 13.4% . His fasting and postprandial hyperglycemia were associated with severe hy perinsulinemia. The patient was diagnosed with type B insulin-resistance sy ndrome by the presence of anti-insulin receptor antibodies. Double-filtrati on plasmapheresis, plasma exchange, and immunosuppressive therapy with cycl ophosphamide and cyclosporin all failed to suppress anti-insulin receptor a ntibodies more than transiently. When we attempted the treatment by daily a dministration of hrIGF-1, fasting and postprandial plasma glucose concentra tions became normal and HbA1c levels decreased to 7.1% over 2 months, until on one occasion administration resulted in anaphylaxis. After the patient became stable, desensitization therapy was performed successfully, and hrIG F-l could be administered again with the plasma glucose returning. We concl uded that ICF-1 therapy was an effective treatment choice for type B insuli n-resistance syndrome in cases whose plasma exchange and immunosuppressive therapy have failed. (C) 2000 Elsevier Science Ireland Ltd. All rights rese rved.