title: A Rare Reason of Hyperinsulinism: Munchausen Syndrome by Proxy.
abstract: Hyperinsulinism, one of the most important causes of hypoglycaemia, can be congenital or acquired. Rarely, drug toxicity can be a reason for hyperinsulinism. In the context of Munchausen syndrome by proxy (MSP), toxicity usually occurs in children due to drug administration by a parent or caregiver. A 7-year-old girl was referred to our department due to a hyperglycaemic period and hypoglycaemic episodes. On admission, gliclazide was initiated due to her hyperglycaemia, which we attributed to maturity onset diabetes of the young. However, during follow-up, hypoglycaemic levels were detected. Despite cessation of gliclazide, hypoglycaemic seizures occurred. Even with the medications administered, hypoglycaemia could not be prevented. During follow-up, the mother's affect, characterized by anxiety and interest in her daughter's medical care, appeared discordant with the situation. Due to our suspicion of MSP, we discovered toxic levels of gliclazide in the blood and urine samples which had been sent to the toxicology laboratory to search for hypoglycaemic agents. The patient was isolated, and all medications were stopped. After isolation, her hypoglycaemia disappeared, and she became hyperglycaemic (250 mg/dl). Physicians should consider the possibility of MSP in hyperinsulinaemic patients with discordant laboratory results and clinical symptoms, even if the child's parents display great concern.
authors.affiliation: Department of Pediatric Endocrinology, Gülhane Military Medical Academy, Ankara, Turkey.
authors.forename: Onur
authors.initials: O
authors.lastname: Akın
authors.forename: Ediz
authors.initials: E
authors.lastname: Yeşilkaya
authors.forename: Erkan
authors.initials: E
authors.lastname: Sari
authors.forename: Çağdaş
authors.initials: Ç
authors.lastname: Akar
authors.forename: Gökalp
authors.initials: G
authors.lastname: Başbozkurt
authors.forename: Enis
authors.initials: E
authors.lastname: Macit
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Aydin
authors.forename: Abdullah
authors.initials: A
authors.lastname: Taşlipinar
authors.forename: Hüsamettin
authors.initials: H
authors.lastname: Gül
mesh_terms: D002648:Child; D005260:Female; D005907:Gliclazide / Q000008:administration & dosage* / Q000009:adverse effects* / Q000493:pharmacokinetics; D006801:Humans; D006946:Hyperinsulinism / Q000097:blood / Q000188:drug therapy; D016735:Munchausen Syndrome by Proxy / Q000097:blood / Q000188:drug therapy
chemical_list: D005907:Gliclazide