# Pitfalls of Hypoglycemia: Uncommon Presentation of Hirata’s Disease in a Caucasian Female

## TL;DR

A rare case of hypoglycemia caused by insulin autoantibodies in a Caucasian woman is reported, highlighting the importance of recognizing this condition in non-Asian populations.

## Contribution

This case expands awareness of insulin autoimmune syndrome in Western populations, where it is uncommon.

## Key findings

- A 53-year-old Caucasian female presented with recurrent hypoglycemia due to insulin autoantibodies.
- Treatment with steroids and dietary changes effectively managed the condition.
- IAS should be considered in differential diagnosis of hypoglycemia to avoid unnecessary diagnostic procedures.

## Abstract

Insulin autoimmune syndrome (IAS) is a known cause of hypoglycemia, more commonly observed in Asian populations, but it is rarely seen in Western countries. We present a case of recurrent hypoglycemia in a 53-year-old Caucasian female, attributed to insulin autoantibodies, which responded well to treatment with steroids and dietary modifications. Increasing awareness of IAS among clinicians is crucial to prevent unnecessary, costly, and potentially harmful diagnostic procedures when investigating recurrent and refractory hypoglycemia, and to ensure appropriate management strategies are implemented.