Case Report

Diabetes Mellitus, Extreme Insulin Resistance, and Hypothalamic-Pituitary Langerhans Cells Histiocytosis

Table 1

Evolution of blood glucose levels, BMI, and anti-insulin receptor antibodies in blood. Evolution of fasting blood venous glycemia (measured at each administration of chemotherapy or at each assessment of anti-insulin receptor antibodies) and the ability of patient’s serum to inhibit insulin binding to its receptor. The reduction of [125I]insulin binding in the presence of patient’s serum (used at 1:3 dilution) was measured on CHO cells overexpressing insulin receptor as described (18-20). Ins: insulin. Met: metformin.

IMC (kg/m2)Anti-insulin receptor antibodiesBlood glucose levels (mM)AdmissionsTherapy for diabetesTherapy for histiocytosis

M-1244,4Stereotactic biopsy
M031,525,8Hyperosmolar hyperglycemic comaInsVinblastine + purinethol
M13215Ins + Met + sulfamidesVinblastine + purinethol
M2314213Ins + Met + sulfamidesVinblastine + purinethol
M232,1358,2Ins + Met + sulfamidesVinblastine + purinethol
M232,1195,5MetVinblastine + purinethol
M833,84313,7Relapse of hyperglycemiaMet + sulfamides + GLP-1 analogVinblastine + purinethol
M1035,24211Met + sulfamides + GLP-1 analogCladribine
M2035,24911Met + sulfamides + GLP-1 analogCladribine
M2837,63014,3Met + sulfamides + GLP-1 analog
M3137,625,5Met + GLP-1 analog
M32393622Relapse of hyperglycemiaInsCladribine
M33393217InsCladribine