Work

A case report of insulin autoimmune syndrome induced by drugs for colorectal cancer

Year: 2025

Type: article

Abstract: RATIONALE: Insulin autoimmune syndrome (IAS) is a rare autoimmune endocrine disease. At present, there are no recognized guidelines. We present a case study of a colorectal cancer patient who was diagnosed with IAS following standard postoperative adjuvant chemotherapy. After comprehensive intervention with glucose supplementation and glucocorticoid therapy successfully normalized the patient's blood glucose levels. This case highlights a potential association between widely prescribed proton pump inhibitors and oxaliplatin chemotherapy with IAS development. These findings emphasize the importance of clinical vigilance for IAS in patients presenting with hypoglycemia. PATIENT CONCERNS: A 70-year-old Chinese male, after colon cancer surgery, has been regularly receiving antitumor treatment with bevacizumab combined with the FOLFOX regimen. After the 8th cycle of this regimen, he developed symptoms of palpitations and cold sweats, with a very low blood glucose level. DIAGNOSES: Considering the patient's medical history, physical examination, and auxiliary examination, the patient was finally diagnosed with IAS. INTERVENTIONS: The patient was given glucose, then the blood glucose level increased, and the symptoms were relieved. Severe hypoglycemia again occurred in the morning on the next day. Prednisone acetate tablets and glucose were given, and blood glucose monitoring was performed. The dosage of prednisone acetate was gradually adjusted in the following days. OUTCOMES: We combined assessments of the history of medication, identified suspicious drugs, and actively treated the patient based on this assessment. Finally, the blood glucose returned to the normal range. LESSONS: This represents the first documented case of IAS triggered by the coadministration of oxaliplatin and omeprazole, addressing a critical knowledge gap regarding autoimmune hypoglycemia induced by the synergistic interaction of these 2 drug classes. Our findings offer novel insights into adverse drug reaction surveillance. For patients receiving chemotherapy in combination with proton pump inhibitors, this case highlights essential diagnostic considerations for identifying IAS as a rare complication - including the temporal relationship between hypoglycemic episodes and medication use, as well as the importance of insulin autoantibody testing. These observations may enhance clinical awareness of atypical hypoglycemia etiologies.

Source: Medicine

DOI: 10.1097/md.0000000000045456

Authors: Xianglei Wu, Leilei Bao, Guorong Fan, Shuowen Wang

Institutions: Second Military Medical University, Shanghai Jiao Tong University, Shanghai First People's Hospital

Language: English

Topic: Adrenal Hormones and Disorders

Subfield: Endocrinology, Diabetes and Metabolism

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: gold

Estimated APC paid: $1,950