{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T05:08:37Z","timestamp":1780463317251,"version":"3.54.1"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,3]],"date-time":"2026-06-03T00:00:00Z","timestamp":1780444800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Insulin 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>We 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\u2019s hypoglycemic episodes were ultimately relieved after discontinuation of the PPI, accompanied by a gradual decrease in the IAA level to the normal range.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key findings<\/jats:title>\n                    <jats:p>HLA analysis revealed HLA-DRB1*0403, DQB1*0302, and DQA1*0301, indicating the patient\u2019s genetic susceptibility to IAS, which was possibly triggered by the PPI.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical relevance<\/jats:title>\n                    <jats:p>This case report may alert clinicians to possible PPI-associated IAS, helping to avoid misdiagnosis and enable patients to receive timely treatment.<\/jats:p>\n                  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