A 21-year-old female @entity1 complaining of frequent hypoglycemic attacks in the presence of a large amount of circulating insulin-binding antibodies without previous known immunization is described. In order to clarify the possible mechanism of the hypoglycemic attacks occurring in this new syndrome, changes in plasma @entity413 , plasma total and free immunoreactive insulin (IRI), and C peptide immunoreactivity (CPR) levels were investigated in the @entity1 before, during, and after a three-hour @entity413 infusion. The character of her antibodies were also examined. An abrupt discontinuation of the @entity413 infusion caused a sharp decline in the plasma @entity413 level, reaching a nadir of 30 mg./100 nk, at 270 minutes; then she became unconscious. A huge amount of total IRI of 2,834 micron U./ml. was registered at 180 minutes, while the peak value of free IRI of 208 micronU./ml. was observed 45 minutes after the cessation of the @entity413 infusion. Plasma CPR was increased from high basal level, 19.6 ng./ml., to the maximum level of 29.2 ng./ml. The maximum insulin-binding capacity of IgG in the patient's serum was 6.25 mU./ml. The antibody-combining site was homogeneous, showing one high-affinity site (K: 1.1 X 10(9)M-1). Neither the prolonged fasting nor the administration of @entity11243 induced the hypoglycemic attack in the @entity1 . The @entity4053 may be explained by an unduly excessive amount of insulin liberated from a large pool of bound insulin irrespective of blood sugar level. The cause of the antibody production is also discussed.

Mechanism of XXXX observed in a @entity1 with insulin autoimmune syndrome.

@entity1 :: ('9606', 'Species') :: ['patient'] @entity11243 :: ('MESH:D014044', 'Chemical') :: ['tolbutamide'] @entity413 :: ('MESH:D005947', 'Chemical') :: ['glucose'] @entity4053 :: ('MESH:D007003', 'Disease') :: ['hypoglycemia']
@entity4053 :: (MESH:D007003,Disease) :: ['hypoglycemia']
