Recurrent hypoglycemia during pregnancies in a woman with multiple autoantibodies including anti-insulin receptor antibody and anti-platelet antibody, whose serum lowered murine blood glucose levels and phosphorylated insulin receptor of CHO-IR cells

Makiko Toshihiro; Hideki Katagiri; Koujiro Kataoka; Akimune Fukushima; Toshie Segawa; Takuya Fujiwara; Isao Hikichi; Noriko Takebe; Jo Satoh

doi:10.1507/endocrj.EJ11-0145

ORIGINALS

Recurrent hypoglycemia during pregnancies in a woman with multiple autoantibodies including anti-insulin receptor antibody and anti-platelet antibody, whose serum lowered murine blood glucose levels and phosphorylated insulin receptor of CHO-IR cells

Makiko Toshihiro, Hideki Katagiri, Koujiro Kataoka, Akimune Fukushima, Toshie Segawa, Takuya Fujiwara, Isao Hikichi, Noriko Takebe, Jo Satoh

Author information

Makiko Toshihiro
Division of Diabetes and Metabolism, Iwate Medical University School of Medicine, Morioka, Japan
Hideki Katagiri
Department of Metabolic Diseases, Center for Metabolic Diseases, Tohoku University Graduate School of Medicine, Sendai, Japan
Koujiro Kataoka
Division of Gastroenterology and Hepatology, Iwate Medical University School of Medicine, Morioka, Japan
Akimune Fukushima
Department of Obstetrics and Gynecology, Iwate Medical University School of Medicine, Morioka, Japan
Toshie Segawa
Division of Endocrinology, Department of Internal Medicine, Iwate Medical University School of Medicine, Morioka, Japan
Takuya Fujiwara
Division of Endocrinology, Department of Internal Medicine, Iwate Medical University School of Medicine, Morioka, Japan
Isao Hikichi
Department of Diabetes, Morioka City Hospital, Morioka, Japan
Noriko Takebe
Division of Diabetes and Metabolism, Iwate Medical University School of Medicine, Morioka, Japan
Jo Satoh
Division of Diabetes and Metabolism, Iwate Medical University School of Medicine, Morioka, Japan

Keywords: Hypoglycemia, Pregnancy, Anti-insulin receptor antibody, Anti-platelet antibody, Phosphorylation of insulin receptor

JOURNAL FREE ACCESS

2011 Volume 58 Issue 12 Pages 1037-1043

DOI https://doi.org/10.1507/endocrj.EJ11-0145

View "Advance Publication" version (September 17, 2011).

Details

Abstract

We report a rare case of recurrent hypoglycemia in a pregnant woman during the period of pregnancies. She suffered from severe hypoglycemia and intrauterine fetal death during the first pregnancy. Thereafter, there was no hypoglycemia, and no obvious cause of hypoglycemia was found by close examinations. Two years later, at eight weeks into the second pregnancy, hypoglycemia recurred. The patient had multiple auto-antibodies including anti-insulin receptor antibody and anti-platelet antibody associated with decreased platelet count. She completed the pregnancy with continuous intravenous administration of glucose that prevented hypoglycemia and finally delivered a healthy baby by Caesarian section. Both the hypoglycemia and thrombocytopenia, and the auto-antibodies disappeared after the delivery. We analyzed the patient’s serum as a possible cause of hypoglycemia. Administration of the serum lowered blood glucose levels of mice more strongly than control serum. In addition, the serum phosphorylated tyrosine of insulin receptor of Chinese hamster ovary cells overexpressing human insulin receptors (CHO-IR cells) in vitro. These results suggest that multiple auto-antibodies might have been induced by a trigger of pregnancy, although the precise mechanism was unclear, and the anti-insulin receptor antibody and anti-platelet antibody might have induced hypoglycemia and thrombocytopenia, respectively, during the pregnancy.

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