Abstract 17: Spontaneous hypoglycaemia due to insulin autoimmune syndrome in five cases, response to steroid therapy and rituximab

Insulin autoimmune syndrome, a rare autoimmune syndrome known as Hirata's disease, was first described by Dr. Hirata of Japan in 1970. It presents as spontaneous recurrent hypoglycaemic attacks. The characteristic presence of anti-insulin auto-antibodies (IAA), increased serum insulin and c peptide levels are the hallmark of this syndrome. It is the third most common cause of spontaneous endogenous hypoglycaemia in Japan. It is triggered by either viruses or sulfhydryl group containing drugs in patients with a genetic predisposition. However, in some cases, no triggering factor is found. In 82% cases, it is a self-emitting disorder treated with the withdrawal of triggering agents and diet therapy. Challenges are observed in refractory cases whose management is still under evolution. Though it is common in Japanese patients, the incidence is increasing in Caucasian and Indian patients. This paper has discussed a series of 5 cases of IAS and approach to diagnosis and different agents used in the management and new patient monitoring techniques.