Factitious hypoglycemia: an unusual clinical picture within Von Münchausen's syndrome.
Two cases of hyperinsulinism from insulin self-administration are described, both patients being admitted to hospital with a diagnosis of insulinoma. In the first case, the diagnosis was clarified after a left pancreatectomy elsewhere, thanks to the discovery of a bottle of insulin. In the second case, the diagnosis was confirmed by the measurement of C-peptide during a hypoglycemic attack. The simultaneous sharp decrease in glucose levels, an exceptional increase in insulinaemia and a reduction or disappearance of serum C-peptide is indicative of this particular type of hyperinsulinism. The two cases described here were remarkably similar. Apart from the most common features, both reported a severe hypoglycemic syndrome of recent onset; negative tolbutamide and calcium tests; a frequent relapse shortly after glucose administration.
D000328:Adult; 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*; D007340:Insulinoma / Q000175:diagnosis; D009110:Munchausen Syndrome / Q000175:diagnosis*; D010190:Pancreatic Neoplasms / Q000175:diagnosis; D012008:Recurrence; D012646:Self Administration
D001786:Blood Glucose; D002096:C-Peptide