Table 1.

Monoclonal Gammopathy-induced Insulin “Autoimmune” Syndrome.

Citation / Year of Report Age (y) / Gender (M/F) Monoclonal Ig Isotype Insulin Antibodies Kinetics Evidence
Essential Monoclonal Gammopathy
4 / 1986 63 / M IgG-kappa Capacity (estimated): 240×10−6 mol L−1
Affinity (estimated): Ka=0.2×106 L mol−1
Specific binding of monoclonal IgG-kappa to insulin
5 / 1989 64 / M IgG-lambda Capacity: 1.7×10−6 mol L−1
Affinity: Ka=1.6×106 L mol−1
Specific binding of monoclonal IgG-lambda to insulin
9 / 1993 48 / F IgG (light chain type not reported) Capacity: Not described
Affinity: Ka=4.0×105 L mol−1
Anti-insulin antibodies identifiable by polyethylene glycol precipitation. 125I-insulin binding by autoradiography to monoclonal IgG on agarose gel electrophoretic separation in an amount that can be decreased by unlabeled insulin
10 / 2004 83 / F IgG-kappa Capacity 1.9×10−5 mol L−1
Affinity: Ka=1.4×106 L mol−1
Anti-insulin antibody corresponded to the monoclonal IgG
3 / 1972 61 / F IgA (light chain type not known) Not studied Hypoglycemia attacks presenting symptom of myeloma. Posited that the hypoglycemia was in some way related to myeloma
6* / 1990 53 / M IgG-kappa Not studied Disappearance of monoclonal IgG-kappa after radiation of sacral lesion and chemotherapy and coincidental disappearance of hypoglycemic episodes and elevated insulin levels
7 / 1992 73 / M IgG-lambda Capacity: 27×10−6 mol L−1
Affinity: Ka=0.085×106 L mol−1
Affinity of IgG-lambda for insulin demonstrated
8 / 1992 78 / M IgG-kappa Not studied IgG-kappa monoclonal immunoglobulin shown to be anti-insulin antibody
11 / 2007 72 / M IgA-kappa Capacity 5.7×10−4 mol L−1
Affinity: Kd=0.32×10−6 mol L−1
IgA-kappa monoclonal immunoglobulin shown to be a low-affinity, high-capacity anti-insulin antibody
12 / 2012 63 / M IgG3-kappa and IgG3-lambda component with insulin-binding capability Capacity: Not reported
Affinity: Ka=7×106 L mol−1
Anti-insulin IgG3-lambda monoclonal antibody distinct from the primary myeloma clone monoclonal IgG3-kappa. Elevated anti-insulin antibody titers and hypoglycemic attacks were closely associated with escape of myeloma from suppression by therapy
*Localized (sacral) myeloma.
RMMJ Rambam Maimonides Medical Journal Rambam Health Care Campus 2015 July; 6(3): e0027. ISSN: 2076-9172
Published online 2015 July 30. doi: 10.5041/RMMJ.10212