title: Factitious hyperinsulinemic hypoglycemia: confirmation of the diagnosis by a species-specific insulin radioimmunoassay.
abstract: Surreptitious self-administration of insulin is an important cause of hypoglycemia. A 28-year-old female hospital ward clerk presented with hypoglycemia associated with an elevated plasma insulin level and a low plasma C-peptide concentration. Factitious illness was denied by the patient until it was definitively proven by using a species-specific insulin radioimmunoassay that the type of insulin circulating at the time of hypoglycemia was of animal rather than of human origin. The differential diagnosis of hypoglycemia associated with hyperinsulinemia and the current laboratory methods which may be employed to distinguish between factitious hypoglycemia and endogenous hyperinsulinism are discussed.
authors.affiliation: Endocrine Division, Mount Sinai Hospital, Toronto, Ontario, Canada.
authors.forename: P G
authors.initials: PG
authors.lastname: Walfish
authors.forename: D S
authors.initials: DS
authors.lastname: Feig
authors.forename: W A
authors.initials: WA
authors.lastname: Bauman
mesh_terms: D000328:Adult; D000818:Animals; D001786:Blood Glucose / Q000032:analysis; D002096:C-Peptide / Q000097:blood; D003937:Diagnosis, Differential; D005162:Factitious Disorders / Q000175:diagnosis*; D005260:Female; D006801:Humans; D006946:Hyperinsulinism / Q000175:diagnosis*; D007003:Hypoglycemia / Q000175:diagnosis*; D007328:Insulin / Q000008:administration & dosage / Q000032:analysis / Q000097:blood; D011863:Radioimmunoassay; D013045:Species Specificity; D013453:Sulfonylurea Compounds / Q000097:blood / Q000652:urine
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D007328:Insulin; D013453:Sulfonylurea Compounds