Successful treatment with plasmapheresis, cyclophosphamide, and cyclosporin A in type B syndrome of insulin resistance. Case report.

Eriksson, Jan W,1959Department of Medicine, Umeå University Hospital, Umeå, Sweden (author)

CASE HISTORY: A woman born in 1949 was diagnosed in 1990 with systemic lupus erythematosus. She was treated with prednisolone, and < 1 year later she presented with marked hyperglycemia. Large doses of insulin were given four times per day. Even though the patient was thin (BMI 17.4 kg/m2), very little improvement was seen. INVESTIGATIONS AND TREATMENT: Serum insulin levels were high, and a euglycemic clamp investigation confirmed severe insulin resistance. The patient's serum contained insulin receptor antibodies inhibiting insulin binding, and thus the patient had a type B syndrome of insulin resistance. After diet and exercise, glycemic control stabilized and insulin treatment was withdrawn. However, in late 1993 she was in a catabolic and hyperglycemic state even though prednisolone doses were increased and azathioprin was added. In early 1994 she was treated with plasmapheresis and cyclophosphamide i.v. Subsequently, cyclosporin A was started as a maintenance therapy in addition to azathioprin. There was a rapid and sustained clinical improvement. Since late 1994 and onward, there is no sign of diabetes or glucose intolerance and there are no demonstrable insulin receptor antibodies in the patient's serum. DISCUSSION: Severe type B insulin resistance may respond favorably to treatment with plasmapheresis and cyclophosphamide followed by cyclosporin A in combination with azathioprin.

MEDICIN OCH HÄLSOVETENSKAP Klinisk medicin Endokrinologi och diabetes hsv//swe
MEDICAL AND HEALTH SCIENCES Clinical Medicine Endocrinology and Diabetes hsv//eng
Adipocytes
metabolism
Animals
Autoantibodies
blood
Combined Modality Therapy
Cyclophosphamide
therapeutic use
Cyclosporine
therapeutic use
Female
Humans
Hyperglycemia
chemically induced
drug therapy
Immunosuppressive Agents
therapeutic use
Insulin
metabolism
therapeutic use
Insulin Resistance
Lupus Erythematosus
Systemic
blood
drug therapy
Middle Aged
Plasmapheresis
Prednisolone
adverse effects
therapeutic use
Rats
Receptor
Insulin
immunology

Bremell, T (author)
Eliasson, Björn,1959Gothenburg University,Göteborgs universitet,Institutionen för invärtesmedicin,Institute of Internal Medicine(Swepub:gu)xelibj (author)
Fowelin, Jesper,1957Gothenburg University,Göteborgs universitet,Institutionen för invärtesmedicin,Institute of Internal Medicine (author)
Fredriksson, L (author)
Yu, Z W (author)
Department of Medicine, Umeå University Hospital, Umeå, SwedenInstitutionen för invärtesmedicin (creator_code:org_t)

By the author/editor: Eriksson, Jan W, ...; Bremell, T; Eliasson, Björn, ...; Fowelin, Jesper, ...; Fredriksson, L; Yu, Z W

About the subject

MEDICAL AND HEALTH SCIENCES: MEDICAL AND HEAL ...; and Clinical Medicin ...; and Endocrinology an ...

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