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Atypical Antiinsulin Receptor Antibodies in a Patient With Type B Insulin Resistance and Scleroderma

Endocrinology Clinic, Hospital do Servidor Publico Municipal (W.B.), and Diabetes and Adrenal Unit, Hospital das Clinicas (B.L. W.) Sao Paulo, Brazil
The Diabetes Branch, National Institute of Diabetes, and Digestive and Kidney Disease, National Institutes of Health (V.Y.M., B.M.S., S.I.T.) Bethesda, Maryland 20892

Address all correspondence and requests for reprints to: Simeon I. Taylor, M.D., Ph.D., National Institutes of Health, Building 10, Room 8N250, Bethesda, Maryland 20892.

We studied a 23-yr-old woman with scleroderma and type B insulin resistance. The association with autoimmune disease suggested that the insulin resistance resulted from autoantibodies to the insulin receptor. However, in preliminary studies, serum antireceptor antibodies were not detected in an assay that measures the ability of the antibodies to inhibit insulin binding to the insulin receptor. Antireceptor antibodies were subsequently detected by their ability to immunoprecipitate affinity-labeled receptors. After the patient had received immunosuppressive therapy with prednisone and cyclophosphamide for 3 months, her insulin resistance remitted, and she developed hypoglycemia. Simultaneously with the remission of insulin resistance, the titer of serum antireceptor antibody (measured by the immunoprecipitation assay) fell to less than 1% of the previous level. In a series of 21 patients, this is the first patient with antireceptor antibodies that bound to the insulin receptor without inhibiting insulin binding

Received April 14, 1988.