Hypoglycaemia due to Autoimmunity

Abstract

Hirata disease is an insulin autoimmune disease characterized by non-exogenous hyper insulinemic postprandial hypoglycemia due to elevated insulin autoimmune antibodies (IAS), with no exogenous insulin and no pathological abnormalities of pancreatic islets cells, the diagnosis is often missed due to the rarity of the disease, failure to diagnose Hirata disease in a timely manner often results in exposing the patients to unnecessary investigation and surgical procedures.
Disease is uncommon in non -Asian population, among Caucasian population, most of the cases is due to drug exposure, autoimmune diseases or hematological malignancies, sometimes Hirata disease can be triggered by viral infection.
In this manuscerpit we will present a case of autoimmune insulin hypoglycemia, patient was subjected to few unnecessary investigations before reaching the correct diagnosis, we reviewed the recent literatures about autoimmunity of endogenous insulin hypoglycemia, we also will suggest the best practice based on our experience given that there is no guidelines to follow due to the rarity of the disease.