Type B Insulin Resistance Syndrome: A Rare Cause of Hypoglycemia

Salman Zahoor Bhat; Sooyoung Lim; Aniket Sidhaye; Amir H Hamrahian

doi:10.1210/jcemcr/luad104

Type B Insulin Resistance Syndrome: A Rare Cause of Hypoglycemia

JCEM Case Rep. 2023 Sep 13;1(5):luad104. doi: 10.1210/jcemcr/luad104. eCollection 2023 Sep.

Authors

Salman Zahoor Bhat¹, Sooyoung Lim¹, Aniket Sidhaye², Amir H Hamrahian²

Affiliations

¹ Division of Endocrinology, Diabetes and Metabolism, John Hopkins University School of Medicine, Baltimore, MD 21287, USA.
² Division of Endocrinology and Metabolism, John Hopkins School of Medicine, Baltimore, MD 21287, USA.

Abstract

We describe a case of a Black female patient with a history of type 2 diabetes mellitus and systemic lupus erythematosus, who had a subacute onset of severe hypoglycemia that persisted after cessation of insulin therapy. Biochemical testing revealed hyperinsulinemic hypoglycemia, normal serum triglycerides, and high-normal serum adiponectin levels. Abdominal imaging demonstrated an 11-mm cystic pancreatic lesion. Her clinical history and biochemical test results raised suspicion for type B insulin resistance syndrome (TBIRS), which was confirmed on anti-insulin receptor antibody testing. The patient's hypoglycemia was managed with dietary modification therapy and continuous glucose monitoring. The severity and frequency of hypoglycemic episodes decreased spontaneously. We describe TBIRS and its uncommon hypoglycemic presentation, analyze factors that put TBIRS among the differential diagnosis, and discuss the treatment of TBIRS-associated hypoglycemia.

Keywords: anti-insulin receptor antibody; autoimmune hypoglycemia; diabetes mellitus; pancreatic cyst; type B insulin resistance syndrome.

Publication types

Case Reports