Pitfalls in Diagnosing Hypoglycemia Due to Exogenous Insulin: Validation and Utility of an Insulin Analog Assay.
Journal
Mayo Clinic proceedings
ISSN: 1942-5546
Titre abrégé: Mayo Clin Proc
Pays: England
ID NLM: 0405543
Informations de publication
Date de publication:
11 2022
11 2022
Historique:
received:
01
04
2022
revised:
24
06
2022
accepted:
25
07
2022
pubmed:
10
10
2022
medline:
9
11
2022
entrez:
9
10
2022
Statut:
ppublish
Résumé
To overcome the limitations of commercially available insulin immunoassays which have variable detection of analog insulin and can lead to clinically discordant results and misdiagnosis in the workup of factitious hypoglycemia. We performed analytical validation of a liquid chromatography high resolution accurate mass (LC-HRAM) immunoassay to detect insulin analogs. We completed clinical assessment using a large cohort of human serum samples from 78 unique individuals, and subsequently used the assay in the evaluation of eight individuals with high diagnostic suspicion for factitious hypoglycemia. The performance characteristics show that the LC-HRAM immunoassay can be applied to detect five commonly used synthetic insulin analogs (lispro, glulisine, aspart, glargine metabolite, and detemir) in human serum. Our clinical cases show that this assay could be used in the diagnosis of factitious hypoglycemia by identifying the analog insulin(s) in question. The LC-HRAM immunoassay reported here overcomes a gap in our diagnostic pathway for hypoglycemia. The results obtained from our studies suggest that this method is appropriate for use in clinical laboratories when factitious hypoglycemia is considered as a differential diagnosis.
Identifiants
pubmed: 36210202
pii: S0025-6196(22)00465-7
doi: 10.1016/j.mayocp.2022.07.021
pmc: PMC9996747
mid: NIHMS1879075
pii:
doi:
Substances chimiques
Insulin
0
Hypoglycemic Agents
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1994-2004Subventions
Organisme : NIDDK NIH HHS
ID : R01 DK078646
Pays : United States
Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2022 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
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