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Factitious hypoglycemia

Amichai Gutgold, David J Gross, Benjamin Glaser, Auryan Szalat
CONTEXT: Hypoglycemia is a rare event in healthy adults, and the differential diagnosis includes many diseases some of which are rare and easily missed. Description of the case: A 20 year-old male military paramedic was referred to our Emergency Department for the investigation of recurrent hypoglycemia episodes during the last months. Factitious hypoglycemia was excluded and organic hyperinsulinemic hypoglycemia was diagnosed by prolonged fast. Imaging studies (endoscopic ultrasound and triple-phase computed tomography) were normal...
October 18, 2016: Journal of Clinical Endocrinology and Metabolism
Francesca Brett, Alan Beausang, William Tormey, Michael Curtis
No abstract text is available yet for this article.
September 19, 2016: Clinical Neuropathology
T Joshi, A Caswell, S Acharya
BACKGROUND: Insulin assays are designed to detect endogenous insulin, but insulin assays produced by different manufacturers may detect exogenous recombinant insulin, with varying degrees of cross-reactivity between different assays. We report a fascinating and difficult case of recurrent hypoglycaemia, where the final diagnosis was established with the help of insulin assays using different platforms.' CASE REPORT: A 24-year-old female presented with recurrent hypoglycaemic episodes on a background of Type 1 diabetes mellitus and a completely resected synovial sarcoma of the right hip several years previously...
May 2, 2016: Diabetic Medicine: a Journal of the British Diabetic Association
Ivana Rabbone, Alfonso Galderisi, Davide Tinti, Maria Giovanna Ignaccolo, Fabrizio Barbetti, Franco Cerutti
The recognition of fabricated illness (FI) in a child represents a diagnostic challenge. The suspicion of FI often arises from the discrepancy between laboratory tests and clinical history. For instance, (unnecessary) insulin injections by caregivers has been widely described as a common cause of factitious hypoglycemia that may be inferred from discrepancies between plasma insulin and c-peptide. However, contemporary administration of insulin with an insulin secretagogue (glyburide), and of additional drugs, can make the diagnostic pathway problematic...
November 2015: Pediatrics
Özlem Nalbantoğlu Elmas, Korcan Demir, Nusret Soylu, Nilüfer Çelik, Behzat Özkan
We report two cases emphasizing the importance of insulin assays for evaluation of hypoglycemia in diabetic patients. Case 1 was a 96/12-year-old female patient with type 1 diabetes mellitus and case 2 was a 1010/12-year-old male patient with DIDMOAD. Both patients were on a basal-bolus insulin regimen. Both were admitted because of persistent hypoglycemia. Analyses of serum samples obtained at the time of hypoglycemia initially showed low insulin and C-peptide levels. Recurrent episodes of unexplained hypoglycemia necessitated measurement of insulin levels by using different insulin assays, which revealed hyperinsulinemic hypoglycemia with low C-peptide levels, findings which confirmed a diagnosis of factitious hypoglycemia...
December 2014: Journal of Clinical Research in Pediatric Endocrinology
Begoña Vega Guedes, Concepción Santana Acosta, Francisco Cabrera, Ana M Wägner
BACKGROUND: Glycemic control in pregnancy complicated by diabetes is important. Spontaneous symptomatic hypoglycemia, in the absence of glucose-lowering treatment, is rare and requires evaluation to prevent harm. CASE: As a result of hypoglycemia, a pregnant woman with type 2 diabetes mellitus had progressive reduction of her insulin requirements until treatment was discontinued at 27 weeks. Despite this, she reported persistent episodes of hypoglycemia. Investigation of possible causes resulted in the discovery that she was covertly treating herself with insulin...
August 2014: Obstetrics and Gynecology
W Heptner, M Badian, S Baudner, C Hellstern, R Irmisch, W Rupp, K Weimer, H Wissmann
An antiserum was prepared for the determination of glibenclamide and for the estimation of other commercially available sulfonylureas. Rabbits were immunized with a glibenclamide-BSA conjugate. Tritiated glibenclamide was used as the tracer. The assay was performed in the presence of 8-anilinonaphthalenesulfonic acid to displace glibenclamide bound to serum protein, and free and antibody bound tracer were separated by dextran-coated charcoal. For glibenclamide determination in serum and plasma the limit of detection was 3 ng/ml...
September 1984: Pharmaceutical Research
Mark J C van Treijen, Ineke M Dijkstra, Henk J T Ruven, Annemarie H Pijlman, N M Marieke van Es, Iris M M J Wakelkamp
Insulin can be measured by immunochemical methods using polyclonal or monoclonal antibodies. Monoclonal antibodies are specific in the detection of pure human insulin, and may show little to no cross reactivity with pro-insulin or recombinant insulin. Polyclonal antibodies, however, do show such cross reactivity. Most medical laboratories use commercial (monoclonal) methods to measure insulin 75% of which are not capable of detecting pro-insulin or exogenous insulin. This pitfall in diagnostics may lead to prolonged uncertainty for both patient and physician, which we illustrate with two patients...
2013: Nederlands Tijdschrift Voor Geneeskunde
Esther Pilar García-Santos, María del Carmen Manzanares-Campillo, David Padilla-Valverde, Pedro Villarejo-Campos, Aurora Gil-Rendo, Virginia Muñoz-Atienza, Susana Sánchez-García, Ana María Puig-Rullán, José Luis Rodríguez-Peralto, Jesús Martín-Fernández
INTRODUCTION: Nesidioblastosis is a rare disease caused by hyperplasia of pancreatic islets, developing a state of hypoglycemia due to an increase in the insulin production. It is the leading cause of hyperinsulinic hypoglycemia in childhood, whereas in adults it only represents the 0.5-5% of cases. The pathogenesis is still unknown. We have studied several genetic mutations associated with dependent potassium channel of ATP present in the beta cells of the pancreas, as well as in patients underwent bariatric surgery because of the metabolic changes involved...
September 2013: Pancreatology: Official Journal of the International Association of Pancreatology (IAP) ... [et Al.]
Michael S Hofman, Rodney J Hicks
The development of a hybrid PET/CT led to the recognition of the enhanced glycolysis in brown fat. We report a previously unrecognized mechanism for altered fluorodeoxyglucose (FDG) biodistribution with diffuse white adipose tissue uptake. This occurred during a restaging scan for cervical cancer following administration of insulin in the setting of measured hyperglycemia. The patient's blood sugar normalized, but she experienced symptoms and signs of hypoglycemia. A subsequent history indicated that the patient received intravenous high-dose vitamin C just prior to arrival...
2011: EJNMMI Research
Efrat Gil, Iveta Mintsman, Efrat Wolfowitz
Patients suffering from this disorder mimic symptoms of diseases and seek medical procedures and operations. We present a case of a patient who underwent a thorough investigation for unexplained persistent hypoglycemia. According to the algorithm approach to the non-diabetic patient, we measured insulin and c-peptide plasma levels while glucose levels were low and looked for sulphonylurea, blood and urine traces. Following the above, an endoscopic ultrasound demonstrated a small pancreatic lesion and an explorative laparotomy was performed to detect an insulinoma...
October 2011: Harefuah
Eugene P Ceppa, Duykhanh P Ceppa, Philip A Omotosho, James A Dickerson, Chan W Park, Dana D Portenier
BACKGROUND: Gastric bypass is a proven treatment option for weight loss and the reduction of medical co-morbid conditions in the obese population. Severe refractory and/or recurrent hypoglycemia can occur, especially in postoperative patients who do not comply with the guidelines for oral glucose consumption. In a very small number of patients, the cause is not dietary indiscretions but, instead, factitious insulin administration or nesidioblastosis. The optimal evaluation and management for these diagnoses is not completely lucid yet important for bariatric surgeons and physicians alike to be familiar...
September 2012: Surgery for Obesity and related Diseases: Official Journal of the American Society for Bariatric Surgery
Rui Takahashi, Yoshitomo Oka
No abstract text is available yet for this article.
July 2010: Nihon Rinsho. Japanese Journal of Clinical Medicine
Jennifer N Osipoff, Nadia Sattar, Mireya Garcia, Thomas A Wilson
Unexplained hypoglycemia in a pediatric diabetic patient can perplex even the savviest health care providers and lead to an extensive medical workup. We present here the cases of 2 children with type 1 diabetes mellitus treated with insulin pumps who were hospitalized for episodes of hypoglycemia. Review of their insulin pumps revealed normal basal and bolus insulin delivery. However, subsequent review of the priming history in the pump revealed that both children were receiving additional insulin under the manual-prime function, which is not included in the daily totals and, therefore, was initially unnoticed...
May 2010: Pediatrics
Hudaverdi Kucuker, Tevfik Demir, Resmiye Oral
Pediatric condition falsification (PCF), also known as Munchausen syndrome by Proxy or Medical Child Abuse, is a somewhat rare form of child abuse and neglect. Its association with a history of adult factitious disorder (AFD) or Munchausen syndrome in the perpetrator is also well known. Exogenous insulin injection to cause hypoglycemia both in the context of PCF and AFD has been reported in the literature. However, the coexistence of both conditions via insulin injection in the same family has not been reported in the literature...
December 2010: Pediatric Diabetes
A C van Bon, N Benhadi, E Endert, E Fliers, W M Wiersinga
OBJECTIVE: To establish the diagnostic performance of the prolonged fasting test in patients suspected of insulinoma. METHODS: We included all patients who were referred to our department between August 1995 and August 2006 with a clinical suspicion of insulinoma. Insulinoma was diagnosed by a positive Whipple's triad during the prolonged fast in combination with an insulin/C-peptide ratio below 1. The presence of insulinoma was confirmed by histopathological data, which was considered the golden standard...
July 2009: Netherlands Journal of Medicine
J Matthew Neal, Wen Han
OBJECTIVE: To report a case of surreptitious insulin use and to review the differences in insulin assays and how they may be optimally used in testing for factitious hypoglycemia. METHODS: We describe the clinical, physical, and laboratory findings of the study patient and review the current relevant literature regarding surreptitious insulin use and detection by insulin assays. RESULTS: A 36-year-old man with type 1 diabetes mellitus was admitted to the hospital with a serum glucose concentration of 28 mg/dL...
November 2008: Endocrine Practice
Barton Kenney, Christopher A Tormey, Lihui Qin, Julie Ann Sosa, Dhanpat Jain, Antonio Neto
CONTEXT: Adult nesidioblastosis, a rare form of abnormal islet cell proliferation arising from the pancreatic ductal epithelium, is usually associated with severe hyperinsulinemic hypoglycemia. Overall, seventy-three cases of nesidioblastosis have been described in the English literature since the entity was first described by Laidlaw in 1938, and only a minute fraction of these have occurred in children. CASE REPORT: We present the case of a previously healthy 45-year-old woman with new-onset severe hypoglycemia 4 and seizures...
2008: JOP: Journal of the Pancreas
J Zeller, P Bougnères
Because the infant's brain is to a large extent dependent on glucose utilization, hypoglycemia of infants can have grave effects on brain function, and it is important to diagnose it and, when possible, treat it promptly. Causes of hypoglycemia in infants are (a) excess insulin secretion, (b) factitious hyperinsulinemia, (c) GH or ACTH deficiency, (d) primary glucocorticoid deficiency, (e) defects of the enzymes involved in hepatic glucose production, or (f) defects in hepatic fatty acid oxidation.
December 1992: Trends in Endocrinology and Metabolism: TEM
Stefan Jenni, Beat Gloor, Christoph Stettler, Emanuel R Christ
No abstract text is available yet for this article.
October 2007: American Journal of Medicine
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