每日一题_2025.05.24

A 47-year-old man with type 2 diabetes presented to the endocrinology clinic owing to several years of progressive growth of skin lesions on his lower abdominal wall where he had repeatedly injected insulin. He also reported unpredictable episodes of hypoglycemia. A physical examination was notable for two pendulous skin masses on the lower abdominal wall. The glycated hemoglobin level was 9.2% (reference value, <7.1). What is the most likely diagnosis?

一名47岁男性2型糖尿病患者因下腹部皮肤病变逐年增大前来内分泌科就诊，他多年来反复在该部位注射胰岛素。他还报告有不可预测的低血糖发作。体格检查发现下腹部有两个悬垂的皮肤肿物。糖化血红蛋白水平为9.2%（参考值＜7.1）。最可能的诊断是什么？

A. Inguinal hernias腹股沟疝

B. Injection site granulomas注射部位肉芽肿

C. Insulin-derived amyloidosis胰岛素源性淀粉样变性

D. Lipoatrophy 脂肪萎缩

E. Lipomas脂肪瘤

答案解析：

胰岛素源性淀粉样变性是指在反复注射胰岛素的部位出现皮下淀粉样物质沉积。若不进行组织病理学评估，胰岛素源性淀粉样变性很难与脂肪增生——另一种反复注射胰岛素导致的皮肤并发症——相区分。这两种情况都可以通过频繁更换胰岛素注射部位来预防。在该病例中，出于美容目的进行了手术切除。组织病理学评估显示有无定形嗜酸性沉积物，刚果红染色呈阳性，并且在偏振光下呈现苹果绿双折射现象。该标本在荧光染色下硫黄素T也呈阳性。

正确答案：C