metricas
covid
Buscar en
Medicina Clínica
Toda la web
Inicio Medicina Clínica Hypoinsulinemic hypoglycemia as a presenting feature of systemic lupus erythemat...
Journal Information

Statistics

Follow this link to access the full text of the article

Letter to the Editor
Hypoinsulinemic hypoglycemia as a presenting feature of systemic lupus erythematosus
Hipoglucemia hipoinsulinémica como manifestación inicial de un lupus eritematoso sistémico
Sarah A. Mahmouda, Mohammed A. Solimanb, Ahmad A. El-Ebiarya,
Corresponding author
a.ebiary@med.tanta.edu.eg

Corresponding author.
a Faculty of Medicine, Tanta University, Tanta, Egypt
b NMC Specialty Hospital, Al Nahda, Dubai, United Arab Emirates
Read
13
Times
was read the article
4
Total PDF
9
Total HTML
Share statistics
 array:24 [
  "pii" => "S0025775320304917"
  "issn" => "00257753"
  "doi" => "10.1016/j.medcli.2020.05.038"
  "estado" => "S300"
  "fechaPublicacion" => "2021-08-13"
  "aid" => "5324"
  "copyright" => "Elsevier España, S.L.U.. All rights reserved"
  "copyrightAnyo" => "2020"
  "documento" => "simple-article"
  "crossmark" => 1
  "subdocumento" => "cor"
  "cita" => "Med Clin. 2021;157:156"
  "abierto" => array:3 [
    "ES" => false
    "ES2" => false
    "LATM" => false
  ]
  "gratuito" => false
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "en" => array:19 [
      "pii" => "S2387020621003508"
      "issn" => "23870206"
      "doi" => "10.1016/j.medcle.2020.05.054"
      "estado" => "S300"
      "fechaPublicacion" => "2021-08-13"
      "aid" => "5324"
      "copyright" => "Elsevier España, S.L.U."
      "documento" => "simple-article"
      "crossmark" => 1
      "subdocumento" => "cor"
      "cita" => "Med Clin. 2021;157:156"
      "abierto" => array:3 [
        "ES" => false
        "ES2" => false
        "LATM" => false
      ]
      "gratuito" => false
      "lecturas" => array:1 [
        "total" => 0
      ]
      "en" => array:10 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
        "titulo" => "Hypoinsulinemic hypoglycemia as a presenting feature of systemic lupus erythematosus"
        "tienePdf" => "en"
        "tieneTextoCompleto" => "en"
        "paginas" => array:1 [
          0 => array:1 [
            "paginaInicial" => "156"
          ]
        ]
        "titulosAlternativos" => array:1 [
          "es" => array:1 [
            "titulo" => "Hipoglucemia hipoinsulin&#233;mica como manifestaci&#243;n inicial de un lupus eritematoso sist&#233;mico"
          ]
        ]
        "contieneTextoCompleto" => array:1 [
          "en" => true
        ]
        "contienePdf" => array:1 [
          "en" => true
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Sarah A&#46; Mahmoud, Mohammed A&#46; Soliman, Ahmad A&#46; El-Ebiary"
            "autores" => array:3 [
              0 => array:2 [
                "nombre" => "Sarah A&#46;"
                "apellidos" => "Mahmoud"
              ]
              1 => array:2 [
                "nombre" => "Mohammed A&#46;"
                "apellidos" => "Soliman"
              ]
              2 => array:2 [
                "nombre" => "Ahmad A&#46;"
                "apellidos" => "El-Ebiary"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "en"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S0025775320304917"
          "doi" => "10.1016/j.medcli.2020.05.038"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => false
            "ES2" => false
            "LATM" => false
          ]
          "gratuito" => false
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775320304917?idApp=UINPBA00004N"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621003508?idApp=UINPBA00004N"
      "url" => "/23870206/0000015700000003/v3_202201060717/S2387020621003508/v3_202201060717/en/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S0025775320305455"
    "issn" => "00257753"
    "doi" => "10.1016/j.medcli.2020.06.049"
    "estado" => "S300"
    "fechaPublicacion" => "2021-08-13"
    "aid" => "5378"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46;"
    "documento" => "article"
    "crossmark" => 1
    "subdocumento" => "sco"
    "cita" => "Med Clin. 2021;157:157"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:11 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Image in medicine</span>"
      "titulo" => "Paraesophageal hernia"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "paginas" => array:1 [
        0 => array:1 [
          "paginaInicial" => "157"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "es" => array:1 [
          "titulo" => "Hernia de hiato paraesof&#225;gica"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:7 [
          "identificador" => "fig0010"
          "etiqueta" => "Fig&#46; 2"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr2.jpeg"
              "Alto" => 639
              "Ancho" => 1625
              "Tamanyo" => 125072
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">A computed tomographic scan showed a retrocardiac mass containing air and liquid&#44; right middle lobe atelectasis and pleural effusion&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Zi-Shan Lin, Xue-Jing Chen, Zhe Jin"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Zi-Shan"
              "apellidos" => "Lin"
            ]
            1 => array:2 [
              "nombre" => "Xue-Jing"
              "apellidos" => "Chen"
            ]
            2 => array:2 [
              "nombre" => "Zhe"
              "apellidos" => "Jin"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2387020621003521"
        "doi" => "10.1016/j.medcle.2020.06.042"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621003521?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775320305455?idApp=UINPBA00004N"
    "url" => "/00257753/0000015700000003/v3_202112201214/S0025775320305455/v3_202112201214/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S0025775320304863"
    "issn" => "00257753"
    "doi" => "10.1016/j.medcli.2020.05.034"
    "estado" => "S300"
    "fechaPublicacion" => "2021-08-13"
    "aid" => "5319"
    "copyright" => "Elsevier Espa&#241;a&#44; S&#46;L&#46;U&#46;"
    "documento" => "simple-article"
    "crossmark" => 1
    "subdocumento" => "cor"
    "cita" => "Med Clin. 2021;157:155"
    "abierto" => array:3 [
      "ES" => false
      "ES2" => false
      "LATM" => false
    ]
    "gratuito" => false
    "lecturas" => array:1 [
      "total" => 0
    ]
    "es" => array:10 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Carta al Editor</span>"
      "titulo" => "Hialohifomicosis invasora con infiltraci&#243;n en m&#233;dula &#243;sea por <span class="elsevierStyleItalic">Engyodontium album</span>"
      "tienePdf" => "es"
      "tieneTextoCompleto" => "es"
      "paginas" => array:1 [
        0 => array:1 [
          "paginaInicial" => "155"
        ]
      ]
      "titulosAlternativos" => array:1 [
        "en" => array:1 [
          "titulo" => "Invasive hyalohyphomycosis with bone marrow infiltration caused by <span class="elsevierStyleItalic">Engyodontium album</span>"
        ]
      ]
      "contieneTextoCompleto" => array:1 [
        "es" => true
      ]
      "contienePdf" => array:1 [
        "es" => true
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Alberto L&#243;pez de Guzm&#225;n, Maria Jos&#233; Buitrago Serna, Mirian Santero Garc&#237;a"
          "autores" => array:3 [
            0 => array:2 [
              "nombre" => "Alberto"
              "apellidos" => "L&#243;pez de Guzm&#225;n"
            ]
            1 => array:2 [
              "nombre" => "Maria Jos&#233;"
              "apellidos" => "Buitrago Serna"
            ]
            2 => array:2 [
              "nombre" => "Mirian"
              "apellidos" => "Santero Garc&#237;a"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "es"
    "Traduccion" => array:1 [
      "en" => array:9 [
        "pii" => "S2387020621003387"
        "doi" => "10.1016/j.medcle.2020.05.051"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => false
          "ES2" => false
          "LATM" => false
        ]
        "gratuito" => false
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "en"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2387020621003387?idApp=UINPBA00004N"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775320304863?idApp=UINPBA00004N"
    "url" => "/00257753/0000015700000003/v3_202112201214/S0025775320304863/v3_202112201214/es/main.assets"
  ]
  "en" => array:13 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Letter to the Editor</span>"
    "titulo" => "Hypoinsulinemic hypoglycemia as a presenting feature of systemic lupus erythematosus"
    "tieneTextoCompleto" => true
    "saludo" => "Dear Editor&#44;"
    "paginas" => array:1 [
      0 => array:1 [
        "paginaInicial" => "156"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Sarah A&#46; Mahmoud, Mohammed A&#46; Soliman, Ahmad A&#46; El-Ebiary"
        "autores" => array:3 [
          0 => array:3 [
            "nombre" => "Sarah A&#46;"
            "apellidos" => "Mahmoud"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Mohammed A&#46;"
            "apellidos" => "Soliman"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
            ]
          ]
          2 => array:4 [
            "nombre" => "Ahmad A&#46;"
            "apellidos" => "El-Ebiary"
            "email" => array:1 [
              0 => "a.ebiary@med.tanta.edu.eg"
            ]
            "referencia" => array:2 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:2 [
          0 => array:3 [
            "entidad" => "Faculty of Medicine&#44; Tanta University&#44; Tanta&#44; Egypt"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "NMC Specialty Hospital&#44; Al Nahda&#44; Dubai&#44; United Arab Emirates"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "titulosAlternativos" => array:1 [
      "es" => array:1 [
        "titulo" => "Hipoglucemia hipoinsulin&#233;mica como manifestaci&#243;n inicial de un lupus eritematoso sist&#233;mico"
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Systemic lupus erythematosus &#40;SLE&#41; is associated with type B insulin resistance syndrome in some patients&#46; Most cases present with high insulin levels&#46; However&#44; few cases may suffer hypoglycemia with low insulin blood levels&#46; We present an atypical case of autoimmune hypoglycemia that was associated with a newly diagnosed SLE on presentation&#46;</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Case presentation</span><p id="par0010" class="elsevierStylePara elsevierViewall">A 33-year-old woman presented to the emergency department with loss of consciousness&#46; The patient was found hypoglycemic &#40;25<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41;&#44; so dextrose 25&#37; was administered immediately&#44; and she regained her full consciousness&#46; The patient reported recurrent attacks of sweating&#44; dizziness and palpitation during fasting over the past year that were attributed to low blood glucose &#40;fasting hypoglycemia&#41;&#46; She had no history of chronic diseases&#44; operations or drug administration&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">The physical examination was unremarkable except for mild hypertension&#44; mild bilateral lower limb edema&#44; and a hyperpigmented skin rash on the cheeks and forehead&#46;</p><p id="par0020" class="elsevierStylePara elsevierViewall">Magnetic resonance imaging of the brain was found normal&#46; On doing the 72-hour fasting test&#44; serum insulin and C-peptide samples were withdrawn at a random blood glucose concentration of 35<span class="elsevierStyleHsp" style=""></span>mg&#47;dl after 13<span class="elsevierStyleHsp" style=""></span>h of fasting&#46; Morning serum cortisol and adrenocorticotropic hormone&#44; thyroid functions&#44; routine laboratory investigations&#44; and analysis for anti-insulin antibodies were requested&#46;</p><p id="par0025" class="elsevierStylePara elsevierViewall">She had an erythrocyte sedimentation rate above 100 in the first hour&#59; leukopenia &#40;leukocytic count<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>2000&#47;mm<span class="elsevierStyleSup">3</span>&#41;&#59; serum creatinine of 1&#46;4<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#59; and positive urine analysis for proteins &#40;&#43;&#43;&#41;&#46; Anti-nuclear antibodies &#40;ANA&#41;&#44; anti-double stranded DNA &#40;anti-dsDNA&#41;&#44; C3&#44; C4&#44; and 24-hour urinary protein were ordered&#44; and the results were positive with high titer of ANA &#40;1&#47;300&#41;&#44; positive anti-dsDNA&#44; and low C3 and C4&#46; The 24-h urinary protein level was 984<span class="elsevierStyleHsp" style=""></span>mg and a renal biopsy was indicated&#46; The fasting insulin and C-peptide levels were very low &#40;1&#46;16<span class="elsevierStyleHsp" style=""></span>&#956;IU&#47;ml and 0&#46;56<span class="elsevierStyleHsp" style=""></span>ng&#47;ml&#44; respectively&#41;&#46; Normal thyroid functions &#40;thyroid stimulating hormone<span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>1&#46;13&#41; and normal morning serum cortisol &#40;28<span class="elsevierStyleHsp" style=""></span>mcg&#47;dl&#41; levels were detected&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The possibility of autoimmune hypoglycemia was investigated despite a negative anti-insulin antibody test&#46; The possibility of a paramalignant condition with insulin-like growth factor 2 secretion was also investigated by performing computed tomography scanning of the chest and abdomen with contrast&#44; and they were found normal except for mild hepatomegaly and bilateral minimal pleural effusion&#46; Serum levels of tumor-markers &#40;CA 19-9 and CEA&#41; were normal&#46; Lupus anticoagulant and anticardiolipin IgG and IgM were negative&#46; The renal biopsy showed diffuse proliferative glomerulonephritis&#46; Consequently&#44; pulse steroid and cyclophosphamide 500<span class="elsevierStyleHsp" style=""></span>mg were administered&#46; Our patient showed improvement in the form of reduced proteinuria &#40;400<span class="elsevierStyleHsp" style=""></span>mg&#47;24<span class="elsevierStyleHsp" style=""></span>h&#41;&#44; decreased serum creatinine &#40;1<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41; and sustained normal blood glucose concentration &#40;90&#8211;130<span class="elsevierStyleHsp" style=""></span>mg&#47;dl&#41; after discharge from hospital for 4 months&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">This is an atypical case of autoimmune hypoglycemia that was associated with a newly diagnosed SLE on presentation&#46; The causes of hypoglycemia in adults are various&#44; including an overdose with drugs &#40;such as insulin or insulin secretagogue&#41;&#44; excess alcohol intake&#44; critical illnesses &#40;hepatic&#44; renal or cardiac failure&#44; sepsis&#41;&#44; cortisol deficiency&#44; hypothyroidism&#44; non-islet cell tumor&#44; insulinoma&#44; autoimmune hypoglycemia&#44; and endogenous insulin secretagogue&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0040" class="elsevierStylePara elsevierViewall">These causes were considered in the differential diagnosis of our patient&#46; The positive findings revealed by the diagnostic work-up indicated a diagnosis of lupus activity and nephritis&#46; Consequently&#44; we postulated that hypoglycemia was the result of an autoimmune condition&#46;</p><p id="par0045" class="elsevierStylePara elsevierViewall">In our patient&#44; anti-insulin-antibody test was negative&#46; Analysis of anti-insulin-receptor antibodies was not available&#44; but the patient was suspected &#8211; mainly through exclusion of other potential etiologies &#8211; to suffer from an atypical form of type B insulin resistance&#46;</p><p id="par0050" class="elsevierStylePara elsevierViewall">The occurrence of hypoglycemia in type B insulin resistance is unusual as the majority of patients suffer from hyperglycemia&#46; However&#44; anti-receptor antibodies were demonstrated to exert insulin-like bioactivity in vitro&#44; thus they may mimic the action of insulin&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Affected individuals often have a history of other autoimmune disorders&#46; Our patient fulfilled six out of 11 criteria for the classification of SLE determined by the American College of Rheumatology and the European League Against Rheumatism&#44; including serositis &#40;pleural effusion&#41;&#44; hematologic disorder &#40;leucopenia&#41;&#44; renal affection &#40;proteinuria and nephritis&#41;&#44; immunologic disorder &#40;high anti-ds antibodies&#44; low C3&#41;&#44; and high titer of ANA&#46;</p><p id="par0060" class="elsevierStylePara elsevierViewall">Glucocorticoid therapy has been reported to improve both hypoglycemia and the activity of SLE&#46; The beneficial effects of glucocorticoids in such cases may be exerted either by inhibiting antibody production or by blocking the post-receptor cellular responses after binding of the antibody to the receptors&#46; Our patient&#44; as well as the similar reported cases&#44;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">3&#8211;5</span></a> showed improvement after administration of steroid therapy&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Funding</span><p id="par0065" class="elsevierStylePara elsevierViewall">This study received no funding from any funding source&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Conflict of interest</span><p id="par0070" class="elsevierStylePara elsevierViewall">The authors declare that they have no conflict of interest&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:4 [
        0 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Case presentation"
        ]
        1 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Funding"
        ]
        2 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Conflict of interest"
        ]
        3 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0015"
          "bibliografiaReferencia" => array:5 [
            0 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Evaluation and management of adult hypoglycemic disorders&#58; an endocrine society clinical practice guideline"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "P&#46;E&#46; Cryer"
                            1 => "L&#46; Axelrod"
                            2 => "A&#46;B&#46; Grossman"
                            3 => "S&#46;R&#46; Heller"
                            4 => "V&#46;M&#46; Montori"
                            5 => "E&#46;R&#46; Seaquist"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1210/jc.2008-1410"
                      "Revista" => array:6 [
                        "tituloSerie" => "J&#46; Clin&#46; Endocrinol&#46; Metab&#46;"
                        "fecha" => "2009"
                        "volumen" => "94"
                        "paginaInicial" => "709"
                        "paginaFinal" => "728"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19088155"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hypoinsulinemic hypoglycemia followed by the onset of severe insulin resistance with hyperglycemia and circulating anti-insulin receptor antibodies in a patient suffering systemic lupus erythematosus&#58; a case report and literature review"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "G&#46;M&#46;d&#46; Pinillos"
                            1 => "M&#46; Tom&#233;"
                            2 => "M&#46;M&#46; Viloria"
                            3 => "J&#46; Bobillo"
                            4 => "M&#46;V&#46; C&#243;zar"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "AACE Clin Case Rep"
                        "fecha" => "2017"
                        "volumen" => "3"
                        "paginaInicial" => "e284"
                        "paginaFinal" => "e288"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Autoantibodies to the insulin receptor as a cause of autoimmune hypoglycemia in systemic lupus erythematosus"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "D&#46;E&#46; Moller"
                            1 => "R&#46;E&#46; Ratner"
                            2 => "D&#46;G&#46; Borenstein"
                            3 => "S&#46;I&#46; Taylor"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/0002-9343(88)90436-6"
                      "Revista" => array:6 [
                        "tituloSerie" => "Am&#46; J&#46; Med&#46;"
                        "fecha" => "1988"
                        "volumen" => "84"
                        "paginaInicial" => "334"
                        "paginaFinal" => "338"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/3044073"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Circulating anti-insulin receptor antibodies in a patient suffering from lupus nephritis and hypoinsulinemic hypoglycaemia"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46; Tardella"
                            1 => "L&#46; Rossetti"
                            2 => "R&#46; De Pirro"
                            3 => "A&#46; Camagna"
                            4 => "F&#46; Leonetti"
                            5 => "G&#46; Tamburrano"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J&#46; Clin&#46; Lab&#46; Immunol&#46;"
                        "fecha" => "1983"
                        "volumen" => "12"
                        "paginaInicial" => "159"
                        "paginaFinal" => "165"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/6663610"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "A case of systemic lupus erythematosus presenting as hypoglycemia due to anti-insulin receptor antibodies"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "Y&#46; Kato"
                            1 => "Y&#46; Ichiki"
                            2 => "Y&#46; Kitajima"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1007/s00296-008-0617-5"
                      "Revista" => array:6 [
                        "tituloSerie" => "Rheumatol&#46; Int&#46;"
                        "fecha" => "2008"
                        "volumen" => "29"
                        "paginaInicial" => "103"
                        "paginaFinal" => "105"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18500459"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/00257753/0000015700000003/v3_202112201214/S0025775320304917/v3_202112201214/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "66430"
    "tipo" => "SECCION"
    "es" => array:2 [
      "titulo" => "Cartas al Editor"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "es"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/00257753/0000015700000003/v3_202112201214/S0025775320304917/v3_202112201214/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0025775320304917?idApp=UINPBA00004N"
]
Article information
ISSN: 00257753
Original language: English
The statistics are updated each day
Year/Month Html Pdf Total
2023 March 2 4 6
2021 November 6 0 6
2021 September 1 0 1

Follow this link to access the full text of the article

es en pt

¿Es usted profesional sanitario apto para prescribir o dispensar medicamentos?

Are you a health professional able to prescribe or dispense drugs?

Você é um profissional de saúde habilitado a prescrever ou dispensar medicamentos