Bahri Evren, Ibrahim Sahi̇n, Selin Genc, Ayshe Slocum, Abdulkadir Bozbay, Emine Sener Aydin

An unusual cause of hypoglycemia; the case of a male patient with Munchausen's Syndrome

Munchausen's Syndrome is a psychiatric illness in which patients create potentially life-threatening symptoms for the purpose of admission to a hospital or other primary gains. A 23-year-old male patient was admitted to the Inonu University, Turgut Ozal Medical Center Endocrinology Inpatient Unit with hypoglycemic attacks. The patient had hypoglycemia that required intensive dextrose infusion. Studies conducted after his hospitalization revealed that the patient intentionally injected himself with high doses of insulin in order to be hospitalized. A diagnosis of factitious hypoglycemia and Munchausen Syndrome (MS) was made. The patient was followed up with recommendations from the psychiatry department. Factitious hypoglycemia, resulting from deliberate usage of blood glucose-lowering medications in the absence of hyperglycemia, is characterized by frequent episodes of hypoglycemia and recurrent hospitalizations and causes a variety of severe symptoms. Typical signs include low blood glucose levels, suppressed c-peptide and pro-insulin levels, and inappropriately high insulin levels. The purpose behind the current case report is to emphasize the significance of considering MS in the differential diagnosis of patients presenting with hypoglycemia and, although it is more prevalent among females, to demonstrate

PDF

___

1. Grunberger G, Weiner JL, Silverman R, et al. Factitious hypoglycemia due to surreptitious administration of insulin. Diagnosis, treatment, and longterm follow-up. Ann Intern Med. 1988 108:252-7.
2. Bhatnagar D. Diagnosis of factitious hypoglycaemia. Br J Hosp Med. 1988 40:140-2.
3. Murray BJ. Hypoglycemia secondary to factitious hyperinsulinism. Postgrad Med. 1981 69:237,240-1.
4. Bass C, Halligan P. Factitious disorders and malingering: challenges for clinical assessment and management. Lancet. 2014;383:1422–32.
5. Kenedi CA, Shirey KG, Hoffa M, et al. Laboratory diagnosis of factitious disorder: a systematic review of tools useful in the diagnosis of Munchausen’s syndrome. N Z Med J. 2011;124:66–81.
6. Kinns H, Housley DFD. Munchausen syndrome and factitious disorder: the role of the laboratory in its detection and diagnosis. Ann Clin Biochem. 2013;50:194–203.
7. Fliege H, Grimm A, Eckhardt-Henn A, et al. Frequency of ICD-10 factitious disorder: survey of senior hospital consultants and physicians in private practice. Psychosomatics. 2007;48:60–4.
8. Yates GP, Feldman MD. Factitious disorder: a systematic review of 455 cases in the professional literature. Gen Hosp Psychiatry. 2016;41:20–8.
9. Beach MC, Gary TL, Price EG, et al. Improving health care quality for racial/ethnic minorities: a systematic review of the best evidence regarding
provider and organization interventions. BMC Public Health. 2006;6:1–11. 10. Tattersall R, Gregory R, Selby C, Kerr D, Heller S. Course of brittle diabetes: 12 year follow up. BMJ. 1991 25;302:1240-3.
11. Schade DS, Drumm DA, Eaton RP, et al. Factitious brittle diabetes mellitus. Am J Med. 1985 78:777-84.
12. Schade DS, Burge MR. Brittle diabetes: etiology and treatment. Adv Endocrinol Metab. 1995;6:289-319.
13. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC; 1994.
14. Asher R. Munchausen’s Syndrome. Lancet. 1951;257:339–41.
15. Goto A, Arah OA, Goto M, et al. Severe hypoglycaemia and cardiovascular disease: systematic review and meta-analysis with bias analysis. BMJ. 2013 29;347:f4533.
16. Fischer CA, Beckson MDP. Factitious disorder in a patient claiming to be a sexually sadistic serial killer. J Forensic Sci. 2017;62:822–6.