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Pantoprazole exposure linked to insulin autoimmune syndrome in case reportStopping a stomach acid drug helped a patient with low blood sugar recover

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Key Takeaway
Consider PPI exposure as a possible trigger for insulin autoimmune syndrome in patients with unexplained hypoglycemia.

This is a case report with a literature review describing a patient who developed insulin autoimmune syndrome (IAS) in temporal association with exposure to the proton pump inhibitor (PPI) pantoprazole. The patient also received beraprost sodium, clopidogrel, and atorvastatin calcium, but the report focuses on pantoprazole as the possible trigger. Genetic testing revealed HLA-DRB1*0403, DQB1*0302, and DQA1*0301 alleles, which may confer susceptibility.

After discontinuation of pantoprazole, the patient's hypoglycemic episodes resolved and insulin autoantibody (IAA) levels gradually decreased to the normal range. Insulin levels also improved. No adverse events or serious adverse events were reported; the only intervention was PPI discontinuation.

The authors note that this is a single case report, so causality and generalizability are limited. The report aims to alert clinicians to the possibility of PPI-associated IAS, which may help avoid misdiagnosis and enable timely treatment. No funding or conflicts of interest were reported.

Imagine a person struggling with dangerous drops in blood sugar. This happens when the body makes antibodies that attack its own insulin. Doctors call this insulin autoimmune syndrome. It is a rare and confusing problem that can be hard to diagnose.

In this case report, a patient took a proton pump inhibitor. This is a common drug that reduces stomach acid. The patient also took other medicines for heart and blood pressure issues. The low blood sugar episodes continued while the patient was on the stomach acid drug.

When the medical team stopped the proton pump inhibitor, the patient began to feel better. The levels of the attacking antibodies dropped back to normal. The dangerous low blood sugar episodes stopped. The patient also had specific genetic markers that might make them more likely to develop this issue when exposed to certain drugs.

This story is a single case, so it cannot prove that the drug causes the condition in everyone. However, it serves as an important alert for doctors. It helps them avoid misdiagnosing patients and ensures people get the right treatment quickly. If you have unexplained low blood sugar, talk to your doctor about all your medications.

What this means for you:
Stopping a stomach acid drug helped a patient with insulin autoimmune syndrome recover.

Study Details

Study typeSystematic review
EvidenceLevel 1
PublishedJun 2026
View Original Abstract ↓
BackgroundInsulin autoimmune syndrome (IAS) is an autoimmune endocrine disorder characterized by hyperinsulinemia, positive insulin autoantibodies (IAA), and hypoglycemia. IAS was previously thought to be induced by drugs containing thiol groups.ObjectiveWe describe a case highlighting that IAS may be temporally associated with a proton pump inhibitor (PPI) exposure. This article reports a patient who took beraprost sodium, clopidogrel, atorvastatin calcium, and the PPI pantoprazole and was subsequently diagnosed with IAS, presenting with a high IAA level, refractory hypoglycemia, and markedly elevated insulin levels. The patient’s hypoglycemic episodes were ultimately relieved after discontinuation of the PPI, accompanied by a gradual decrease in the IAA level to the normal range.Key findingsHLA analysis revealed HLA-DRB1*0403, DQB1*0302, and DQA1*0301, indicating the patient’s genetic susceptibility to IAS, which was possibly triggered by the PPI.Clinical relevanceThis case report may alert clinicians to possible PPI-associated IAS, helping to avoid misdiagnosis and enable patients to receive timely treatment.
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