title: Anemia and neutropenic fever with high dose diazoxide treatment in a case with hyperinsulinism due to Munchausen by proxy.
abstract: BACKGROUND
  The etiology of hyperinsulinemic hypoglycemia in adolescents is similar to that of adults. Patients resistant to medical treatment may undergo pancreatectomy. Diazoxide is the mainstay of medical treatment. Rarely bone marrow suppression is reported due to diazoxide.
  
  
  METHODS
  An adolescent with severe hyperinsulinemic hypoglycemia was referred for pancreatectomy after she was treated with high doses of diazoxide, octreotide and glucose. She developed anemia and febrile neutropenia in the course of diazoxide treatment that resolved with cessation of medication. The cause of the hyperinsulinemia proved to be classical Munchausen by proxy.
  
  
  CONCLUSIONS
  This is the first report of bone marrow suppression involving erythroid series by diazoxide. Follow-up of blood count may be considered in patients on high dosages since anemia may be dose dependent. Munchausen by proxy poses a serious threat to children with significant morbidity and mortality. Awareness and a high index of suspicion in clinical settings with unusual causes are the mainstay for the diagnosis.
authors.affiliation: Division of Endocrinology, Department of Pediatrics, Hacettepe University Faculty of Medicine, Sihhiye, Ankara, Turkey. azeynep@hacettepe.edu.tr
authors.forename: A
authors.initials: A
authors.lastname: Ozon
authors.forename: H
authors.initials: H
authors.lastname: Demirbilek
authors.forename: A
authors.initials: A
authors.lastname: Ertugrul
authors.forename: S
authors.initials: S
authors.lastname: Unal
authors.forename: F
authors.initials: F
authors.lastname: Gumruk
authors.forename: N
authors.initials: N
authors.lastname: Kandemir
mesh_terms: D000740:Anemia / Q000139:chemically induced*; D001853:Bone Marrow / Q000187:drug effects; D002648:Child; D003981:Diazoxide / Q000009:adverse effects*; D005260:Female; D005334:Fever / Q000209:etiology*; D006801:Humans; D006946:Hyperinsulinism / Q000188:drug therapy* / Q000209:etiology; D016735:Munchausen Syndrome by Proxy / Q000150:complications*; D009503:Neutropenia / Q000139:chemically induced*
chemical_list: D003981:Diazoxide