RESUMO
Insulin autoimmune syndrome is an unusual cause of spontaneous hypoglycaemia in non-Asian populations. In the majority of cases, this syndrome appears a few weeks after the administration of drugs containing a sulfhydryl group. A strong association between this syndrome and HLA-DR4 has been shown. Only seven cases have been described in non-Asian patients. We report the first case of insulin autoimmune syndrome in an Argentine woman taking alfa-lipoic acid. She developed hypoglycaemic symptoms approximately 1 month after starting therapy. Blood sampling collected during an episode of symptomatic hypoglycaemia showed low blood glucose level (2.39 mmol/L), high level of serum insulin (1971.55 pmol/L), inappropriately high level of C-peptide (2.36 nmol/L) and high levels of insulin antibodies (274.78 IU/mL). HLA-DNA typing identified DRB1*04:03. Due to the widespread use of alfa-lipoic acid for its antioxidant properties, clinicians should be aware that it may trigger an autoimmune hypoglycaemia in people with a genetic predisposition.
RESUMO
In a combined approach, endocrine and ultrasonic analyses were performed to assess reproduction of two syntopic populations of terrestrial Galápagos iguanas the Conolophus marthae (the Galápagos Pink Land Iguana) and C. subcristatus on the Volcán Wolf (Isabela Island). The ELISA methods (enzyme-linked immunosorbent assay) were used to measure plasma concentrations of progesterone (P4) and 17ß-estradiol (E2) from samples collected over the course of three different seasons: July 2010, June 2012-2014. As for C. subcristatus, the large number of females with eggs in 2012 and 2014 were associated with increased plasma P4 concentrations and the corresponding absence of females with eggs in July 2010 when concentrations of both hormones levels were basal indicating reproduction was still ongoing in June and had ended in July. In C. marthae, even though there was a positive relationship between egg-development stages and hormone concentrations, P4 concentrations were basal through the three years that samples were collected, with some females having a lesser number of eggs compared with C. subcristatus. In C. marthae P4 and E2 patterns did not allow for defining a specific breeding season.