Abstract: Objective To analyze the clinical features of patients with insulin autoimmune syndrome in China, Japan and non-Asian population. Methods Compared with the clinical data among nine cases of insulin autoimmune syndrome who were diagnosed in the General Hospital of the People's Liberation Army, domestic cases summarized by Peking Union Medical College, Japanese cases and non-Asian cases. Results No gender difference was found in the onset characteristics of insulin autoimmune syndrome(IAS). The onset age was in a wide range and the patients older than 40 years were more frequently seen. Most Asian cases were strongly associated with Graves disease and medications containing the sulfhydryl group, such as thiamazole. Most non-Asian cases were associated with rheumatologic disease and hematologic disease. IAS was characterized by severe spontaneous hypoglycemic episodes, elevated insulin levels and positive insulin autoantibodies. The episodes of hypoglycemia occurred in both fasting and postprandial states. The prognosis of IAS was good, and the hypoglycemia always resolved completely in 1-3 months. The main treatment of IAS included diet improvement and offending drugs withdrawal, which released most Japanese syndrome. But for Chinese and non-Asian cases, they treated with oral prednisone more frequently. Conclusion The clinical features of IAS are special. To assay insulin autoantibodies is greatly helpful to distinguish IAS from the patients with hypoglycemia and hyperinsulinism. The treatment of IAS is simple and the prognosis is good. The early diagnosis and correct therapy can avoid the episodes of harmful events.

Key words: insulin autoimmune syndrome, hypoglycemia, insulin autoantibodies