RICHARD C. BECKER, M.D.; RAQUEL G. MARTIN, D.O.
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To the editor: A recent letter (1) discusses the effect of D-penicillamine on carbohydrate metabolism. This phenomenon has, in fact, been described previously (2) and has been ascribed to the presence of insulin antibodies.
D-Penicillamine is known to cause a number of autoimmune diseases including Goodpasture's syndrome, myasthenia gravis, polymyositis, and systemic lupus erythematosus (3). It has been postulated that penicillamine-containing sulfhydryl groups may interact with disulfide bonds of endogenous proteins (insulin included), altering their structure and making them immunogenic (2). Hypoglycemia may result from the dissociation of insulin from its binding antibody during the fasting state. Spontaneously occurring antibodies
BECKER RC, MARTIN RG. Penicillamine-Induced Insulin Antibodies. Ann Intern Med. ;104:127–128. doi: 10.7326/0003-4819-104-1-127_2
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Published: Ann Intern Med. 1986;104(1):127-128.
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