RECURRENT, severe hypoglycemia in the absence of exogenous insulin administration is uncommon. Reported causes include islet-cell adenomas or carcinomas, surreptitious use of insulin or sulfonylurea medications, stimulatory insulin-receptor antibodies, and various non—islet-cell tumors.1 2 3 4 The autoimmune insulin syndrome is another rare cause of hypoglycemia.5,6 This syndrome is characterized by late postprandial hypoglycemia and the presence of polyclonal insulin-binding autoantibodies, typically occurring in a patient with other autoimmune disease. Excess insulin is released in response to a meal because of binding to antibodies. Later, as the bound insulin is released, it causes hypoglycemia. We describe a patient who presented with a hypoglycemic.
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