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https://read.qxmd.com/read/37908465/insulin-immunoassay-interference-due-to-human-antimouse-antibodies-in-a-patient-with-ketotic-hypoglycemia
#1
Meghan Craven, Katherine Lord, Karla F Leavens, Diva D De Leon
Misinterpretation of common endocrine hormonal immunoassays can distort the clinical picture and lead to unnecessary medical workups. Potential assay inference is important to recognize when the clinical presentation and laboratory evaluation are inconsistent. This is demonstrated by the case of an 18-month-old girl who initially presented with ketotic hypoglycemia and was found on diagnostic fasting evaluation to have the triad of hypoglycemia, inappropriately high insulin levels, and low C-peptide levels-point-of-care glucose 43 mg/dL (2...
March 2023: JCEM Case Rep
https://read.qxmd.com/read/37583724/new-and-delayed-artifactual-hypoglycemia-following-septic-shock-in-two-scleroderma-patients
#2
Alex Guzner, Emil Heinze, Lakshmi Sadasivam
The term artifactual hypoglycemia refers to a discrepancy between plasma glucose levels and what is noted on fingerstick glucose checks. In this report, we discuss the cases of two patients with scleroderma and Raynaud's phenomenon who developed artifactual hypoglycemia while recovering from critical illness. In both cases, validation by earlobe measurements helped avoid further escalation of care and potential patient safety issues. There have been previous reports of artifactual hypoglycemia in this patient population, but the unique timing of symptom onset in these two patients provides a more nuanced understanding of the pathophysiology of this phenomenon...
July 2023: Curēus
https://read.qxmd.com/read/37013583/munchausen-syndrome-by-proxy-a-case-report
#3
JOURNAL ARTICLE
Fadiah Alkhattabi, Israa Bamogaddam, Afaf Alsagheir, Abdullah Al-Ashwal, Raghad Alhuthil
BACKGROUND: Inappropriately high levels of insulin secretion can cause the potentially fatal condition of persistent hyperinsulinemic hypoglycemia of infancy. Our paper focuses on another cause of severe hypoglycemia, which can be easily missed. CASE PRESENTATION: An 18-month-old Saudi female was referred to our hospital for further investigation and management of her recurrent hypoglycemic attacks as a case of persistent hyperinsulinemic hypoglycemia of infancy...
April 4, 2023: Journal of Medical Case Reports
https://read.qxmd.com/read/36965853/factitious-hypoglycemia-in-insulin-treated-diabetic-patients
#4
JOURNAL ARTICLE
Thierry Galvez, Manuela Lotierzo, Guilhem Conquet, Quentin Verani, Caroline Aguilhon, Isabelle Rangeard, Jean Paul Cristol, Eric Renard
Factitious hypoglycemia is a factitious disorders according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), referring to intentionally covertly induced hypoglycemia, with potentially severe consequences. Knowledge of factitious hypoglycemia relies on case reports, and evidence-based information and guidelines are lacking. Diagnosing factitious hypoglycemia in insulin-treated diabetic persons is therefore challenging and often requires a long and costly process. Moreover, the typical metrics proposed to differentiate insulin-induced factitious hypoglycemia from insulinoma (i...
March 23, 2023: Annales D'endocrinologie
https://read.qxmd.com/read/36733550/factitious-hypoglycemia-in-an-infant-with-undetectable-exogenous-insulin-by-a-commercial-insulin-immunoassay-a-diagnostic-pitfall
#5
Hisham Arabi, Amir Babiker, Asma M Awadalla, Faroug Ababneh, Maha A AlMuneef
Factitious hypoglycemia in infancy is a rare, life-threatening manifestation of Munchausen syndrome by proxy (MSBP). The hallmark of such presentation is the detection of low c-peptide combined with high insulin at the time of hypoglycemia. We report the case of a male infant who presented with recurrent severe unexplained hypoglycemic episodes since the age of six months. Two of his siblings had similar unexplained hypoglycemia episodes at a young age. He was extensively investigated, and all were normal, for endocrine and metabolic etiologies...
January 2023: Curēus
https://read.qxmd.com/read/36376919/munchausen-syndrome-with-factitious-hypoglycemia-due-to-deliberate-insulin-analog-administration-and-factitious-hyperglycemia-in-a-patient-with-hypothyroidism
#6
JOURNAL ARTICLE
Marina Yukina, Ilana Katsobashvili, Nadezhda Platonova, Ekaterina Troshina, Galina Mel'nichenko
BACKGROUND: Hypoglycemic syndrome is a potentially life-threatening condition that can lead to the disruption of brain and internal organ functions, and in severe cases to irreparable consequences or death. Factitious hypoglycemia (FH) is the deliberate use of insulin preparations or oral hypoglycemic drugs with the aim of lowering blood glucose levels into the pathologically-hypoglycemic range. Deliberate administration of insulin analogs may be difficult to prove because they might not have epitopes or containing low affinity epitopes that are the targets of antibodies used in particular assay kits...
November 15, 2022: Clinical Diabetes and Endocrinology
https://read.qxmd.com/read/36255518/accurate-selection-of-insulin-immunoassay-to-discern-factitious-hypoglycemia-a-case-report
#7
JOURNAL ARTICLE
Manuela Lotierzo, Thierry Galvez, Guilhem Conquet, Quentin Verani, Caroline Aguilhon, Isabelle Rangeard, Jean Paul Cristol, Eric Renard
No abstract text is available yet for this article.
October 18, 2022: Acta Diabetologica
https://read.qxmd.com/read/36225520/when-a-histologic-diagnosis-becomes-factitious-a-case-of-munchausen-syndrome
#8
Mafalda Teixeira, Pedro Santos, Ana Bastos Furtado, José Delgado Alves
Recurrent episodes of hypoglycemia are uncommon in non-diabetic patients. The workup investigation must confirm hypoglycemia and distinguish between endogenous versus exogenous hyperinsulinism. Simultaneous measurements of plasma glucose, insulin, C-peptide, and a screen for oral hypoglycemic agents should be performed. According to the results, further imaging studies may be necessary. A 43-year-old woman suffering from recurrent hypoglycemia presented to the emergency room (ER) with a hypoglycemic coma. She has had multiple episodes of documented hypoglycemia for the last 13 years...
September 2022: Curēus
https://read.qxmd.com/read/36210202/pitfalls-in-diagnosing-hypoglycemia-due-to-exogenous-insulin-validation-and-utility-of-an-insulin-analog-assay
#9
JOURNAL ARTICLE
Aoife M Egan, Kornelia D Galior, Anthony D Maus, Erica Fatica, Vinaya Simha, Pankaj Shah, Ravinder J Singh, Adrian Vella
OBJECTIVE: To overcome the limitations of commercially available insulin immunoassays which have variable detection of analog insulin and can lead to clinically discordant results and misdiagnosis in the workup of factitious hypoglycemia. PATIENTS AND METHODS: We performed analytical validation of a liquid chromatography high resolution accurate mass (LC-HRAM) immunoassay to detect insulin analogs. We completed clinical assessment using a large cohort of human serum samples from 78 unique individuals, and subsequently used the assay in the evaluation of eight individuals with high diagnostic suspicion for factitious hypoglycemia...
November 2022: Mayo Clinic Proceedings
https://read.qxmd.com/read/35898373/hypoglycemia-and-factitious-disorders-a-case-report-and-review
#10
Arya Sharifzadeh
Hypoglycemia may present with a multitude of signs and symptoms ranging from subjective feelings of anxiety or diaphoresis to neuroglycopenic manifestations of altered sensorium or seizure. The differential diagnosis of hypoglycemic disorders is broad, and in rare instances may occur following intentional induction by undisclosed insulin administration or insulin secretagogue ingestion in patients with an underlying factitious disorder. While basic laboratory studies can reliably confirm the presence of exogenous insulin in patients with hyperinsulinemic hypoglycemia, increased endogenous insulin secretion following sulfonylurea ingestion can mimic a biochemical pattern of findings also seen with insulinoma, a rare pancreatic insulin-producing tumor...
June 2022: Curēus
https://read.qxmd.com/read/35602882/discordant-timing-of-hypoglycemic-agent-screening-causing-delayed-diagnosis-of-sulfonylurea-induced-hypoglycemia
#11
Andrew Folick, Cheng Cheng, Simon N Chu, Jonathan W Rick, Robert J Rushakoff
Background: Oral hypoglycemic agents are a frequent cause of hypoglycemia in nondiabetic people. Here, we report a case of recurrent hypoglycemia caused by glipizide, in which diagnosis was delayed because of a combination of delayed hypoglycemic agent screening and low sensitivity of the hypoglycemic agent screening panel used. Case Report: A 66-year-old woman repeatedly presented with symptomatic hypoglycemia. At the first presentation, the serum glucose level was 40 mg/dL (2...
May 2022: AACE Clinical Case Reports
https://read.qxmd.com/read/34529061/attempted-murder-of-a-young-child-followed-by-an-attempted-suicide-of-the-mother-by-injection-of-insulin-aspart-identification-of-quantification-of-insulin-by-lc-hrms-and-uplc-ms-ms-in-blood-of-the-two-cases
#12
JOURNAL ARTICLE
Nadia Arbouche, Estelle Godard, Laurie Gheddar, Jean-Sébastien Raul, Pascal Kintz
The identification and quantification of insulin and its analogues have always been a challenge in the forensic field. Murder, suicide attempts and induced hypoglycemia in the context of factitious disorders have been described with the use of synthetic analogues of human insulin. There is very few information in the literature about aspart insulin concentrations in overdose cases. In this paper, we present a case of a nurse who tried to murder her 10-year-old daughter by injecting her aspart insulin and who, later, tried to commit suicide by injecting herself the same hormone...
September 16, 2021: Journal of Analytical Toxicology
https://read.qxmd.com/read/34040920/insulin-as-a-tool-in-factitious-dysglycemia
#13
Samih A Odhaib, Qussay N Almaliki, Abbas A Mansour
Factitious dysglycemia is a type of self-inflicted harm that includes deliberate attempts to induce hypo- or hyperglycemia as a sickness to gain empathy. We report the cases of three Iraqi women with different motives to induce factitious dysglycemia. Two of them had used insulin to induce hypoglycemia to have their family affection centered on them again. The third woman with type 1 diabetes mellitus intentionally missed her insulin doses to induce diabetic ketoacidosis and gain familial empathy through recurrent hospital admission, with underlying suicidal ideation...
April 22, 2021: Curēus
https://read.qxmd.com/read/34020705/high-dose-vitamin-c-induced-prolonged-factitious-hyperglycemia-in-a-peritoneal-dialysis-patient-a-case-report
#14
JOURNAL ARTICLE
Olivier Lachance, François Goyer, Neill K J Adhikari, Marie-Hélène Masse, Jean-François Bilodeau, François Lamontagne, Marc-André Leclair
BACKGROUND: High-dose vitamin C is increasingly used for sepsis and more recently for coronavirus disease 2019 (COVID-19) infections. Proponents argue that the low cost and near perfect safety profile of vitamin C support its early adoption. Yet, adverse events might be underreported and underappreciated. CASE PRESENTATION: We report a 73-year-old non-diabetic white man with end-stage renal disease on peritoneal dialysis admitted to the intensive care unit with septic shock that was suspected to be due to peritonitis...
May 21, 2021: Journal of Medical Case Reports
https://read.qxmd.com/read/30862762/pitfalls-in-the-diagnosis-of-insulin-autoimmune-syndrome-hirata-s-disease-in-a-hypoglycemic-child-a-case-report-and-review-of-the-literature
#15
Tiago Jeronimo Dos Santos, Caroline Gouvêa Buff Passone, Marina Ybarra, Simone Sakura Ito, Milena Gurgel Teles, Thais Della Manna, Durval Damiani
Background Insulin autoimmune syndrome (IAS) is a rare cause of hyperinsulinemic hypoglycemia (HH) not addressed as a potential differential diagnosis in current pediatric guidelines. We present a case of IAS in a child with no previous history of autoimmune disease, no previous intake of triggering medications and absence of genetic predisposition. Case presentation A 6-year-old boy presented with recurrent HH (blood glucose of 26 mg/dL [1.4 mmol/L] and insulin of 686 μU/mL). Abdominal imaging was normal...
March 13, 2019: Journal of Pediatric Endocrinology & Metabolism: JPEM
https://read.qxmd.com/read/30537938/hypoglycemia-secondary-to-factitious-hyperinsulinism-in-a-foster-care-adolescent-a-case-report-of-munchausen-syndrome-in-a-community-hospital-emergency-department-setting
#16
JOURNAL ARTICLE
Ashruta Patel, Gary Daniels
BACKGROUND: Factitious disorder causing hypoglycemia is a psychiatric condition in which patients deliberately use blood sugar lowering medications to cause severe symptoms for the purposes of hospitalization or other primary gains. CASE PRESENTATION: We report a case of factitious hypoglycemia in a 19-year-old foster care adolescent female who presented to the Emergency Department with recurrent hypoglycemic episodes, to the degree that the patient required large amounts of dextrose and further management by intensive care unit hospitalization...
December 11, 2018: BMC Emergency Medicine
https://read.qxmd.com/read/29991462/factitious-hypoglycemia-a-never-ending-story
#17
JOURNAL ARTICLE
Jean-Louis Bayart, Mélanie Closset, Alexandra Coulon, Raluca-Maria Furnica, Damien Gruson
Our team of diabetologist is challenged by the case of a 41 year-old woman with recurrent hypoglycaemic episodes. Her clinical background was complex with, among others, a neuroendocrine tumor, a nonalcoholic steatohepatitis and an adrenal insufficiency; these conditions require the exploration of several potential causes. After excluding an endogenous etiology, a factitious hypoglycemia was quicky suspected by clinicians. However, several venous samples showed normal insulinemia and a moderately decreased C-peptide...
August 1, 2018: Annales de Biologie Clinique
https://read.qxmd.com/read/29805453/factitious-hypoglycemia-caused-by-a-unique-pattern-of-drug-use-a-case-report
#18
JOURNAL ARTICLE
Mojtaba Akbari, Akbar Soltani, Mohammad Reza Mohajeri-Tehrani, Hamidreza Aghaei Meybodi, Imaneh Sadat Mousavi Fakhr, Sayed Mahmoud Sajjadi-Jazi
Introduction: Factitious hypoglycemia, caused by the surreptitious use of insulin and sulfonylureas, is one of the most challenging differential diagnoses of hypoglycemia. Diagnosis is usually established via exclusion with respect to the special patterns of plasma insulin and C-peptide during hypoglycemic episodes. Case Presentation: We report a case of recurrent hypoglycemic episodes and confusing patterns of insulin and C-peptide levels. In the primary evaluations, insulinoma was suspected considering the high plasma concentrations of insulin and C-peptide, besides negative urine and plasma sulfonylureas during hypoglycemic episodes...
January 2018: International Journal of Endocrinology and Metabolism
https://read.qxmd.com/read/29625854/relevance-of-insulin-immunoassay-characteristics-in-factitious-hypoglycemia
#19
JOURNAL ARTICLE
Andreu Simó-Servat, Eduard Montanya
No abstract text is available yet for this article.
May 2018: Endocrinología, Diabetes y Nutrición
https://read.qxmd.com/read/29464887/factitious-hypoglycemia-in-children-and-adolescents-with-diabetes
#20
REVIEW
Viviana Bauman, Adaya C Sturkey, Rosa Sherafat-Kazemzadeh, Jennifer McEwan, Paul M Jones, Ashley Keating, Elvira Isganaitis, Alyne Ricker, Kristina I Rother
BACKGROUND: Factitious hypoglycemia is a condition of self-induced hypoglycemia due to surreptitious administration of insulin or oral hypoglycemic agents. In adults, it is an uncommon, but well known clinical entity observed in individuals with and without diabetes. OBJECTIVES: To report a case of factitious hypoglycemia highlighting diagnostic pitfalls, to identify common characteristics of children and adolescents with factitious hypoglycemia, and to examine whether the information on long-term outcome exists...
June 2018: Pediatric Diabetes
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