{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T05:53:10Z","timestamp":1780465990121,"version":"3.54.1"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2023,10,11]],"date-time":"2023-10-11T00:00:00Z","timestamp":1696982400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100004440","name":"Wellcome Trust","doi-asserted-by":"publisher","award":["210752\/Z\/18\/Z"],"award-info":[{"award-number":["210752\/Z\/18\/Z"]}],"id":[{"id":"10.13039\/100004440","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,12,6]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>In very rare cases of monoclonal gammopathy, insulin-binding paraprotein can cause disabling hypoglycaemia. We report a 67-year-old man re-evaluated for hyperinsulinaemic hypoglycaemia that persisted despite distal pancreatectomy. He had no medical history of diabetes mellitus or autoimmune disease but was being monitored for an IgG kappa monoclonal gammopathy of undetermined significance. On glucose tolerance testing, hyperglycaemia occurred at 60\u2005min (glucose 216\u2005mg\/dL) and hypoglycaemia at 300\u2005min (52\u2005mg\/dL) concurrent with an apparent plasma insulin concentration of 52 850\u2005pmol\/L on immunoassay. Laboratory investigation revealed an IgG2 kappa with very high binding capacity but low affinity (Kd 1.43 \u00d7 10\u22126\u2005mol\/L) for insulin. The monoclonal gammopathy was restaged as smouldering myeloma not warranting plasma cell\u2013directed therapy from a haematological standpoint. Plasma exchange reduced paraprotein levels and improved fasting capillary glucose concentrations. Lenalidomide was used to treat disabling hypoglycaemia, successfully depleting paraprotein and leading to resolution of symptoms.<\/jats:p>","DOI":"10.1093\/ejendo\/lvad138","type":"journal-article","created":{"date-parts":[[2023,10,11]],"date-time":"2023-10-11T10:59:11Z","timestamp":1697021951000},"page":"K25-K29","source":"Crossref","is-referenced-by-count":5,"title":["Resolution of dysglycaemia after treatment of monoclonal gammopathy of endocrine significance"],"prefix":"10.1093","volume":"189","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1121-9211","authenticated-orcid":false,"given":"Bonnie","family":"Grant","sequence":"first","affiliation":[{"name":"Department of Endocrinology, St Bartholomew\u2019s Hospital, Barts Health NHS Trust , London EC1A 7BE , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gowri","family":"Ratnayake","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, St Bartholomew\u2019s Hospital, Barts Health NHS Trust , London EC1A 7BE , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claire L","family":"Williams","sequence":"additional","affiliation":[{"name":"Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research, Southmead Hospital , Bristol BS10 5NB , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6847-2771","authenticated-orcid":false,"given":"Anna","family":"Long","sequence":"additional","affiliation":[{"name":"Translational Health Sciences, Bristol Medical School, University of Bristol, Learning and Research, Southmead Hospital , Bristol BS10 5NB , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J","family":"Halsall","sequence":"additional","affiliation":[{"name":"Department of Clinical Biochemistry and Immunology, Cambridge University Hospitals NHS Foundation Trust , Cambridge CB2 0QQ , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6539-3069","authenticated-orcid":false,"given":"Robert K","family":"Semple","sequence":"additional","affiliation":[{"name":"Centre for Cardiovascular Science, Queen\u2019s Medical Research Institute, University of Edinburgh , Edinburgh EH16 4TJ , United Kingdom"},{"name":"MRC Human Genetics Unit, Institute of Genetics and Cancer, The University of Edinburgh , Edinburgh EH4 2XU , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James D","family":"Cavenagh","sequence":"additional","affiliation":[{"name":"Department of Haematolo-Oncology, St Bartholomew\u2019s Hospital , Barts Health NHS Trust, London EC1A 7BE , United Kingdom"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William M","family":"Drake","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, St Bartholomew\u2019s Hospital, Barts Health NHS Trust , London 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