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Factitious Hypoglycemia Caused by a Unique Pattern of Drug Use: A Case Report

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 hypog...

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Autores principales: Akbari, Mojtaba, Soltani, Akbar, Reza Mohajeri-Tehrani, Mohammad, Aghaei Meybodi, Hamidreza, Sadat Mousavi Fakhr, Imaneh, Mahmoud Sajjadi-Jazi, Sayed
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Kowsar 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5961186/
https://www.ncbi.nlm.nih.gov/pubmed/29805453
http://dx.doi.org/10.5812/ijem.62591
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author Akbari, Mojtaba
Soltani, Akbar
Reza Mohajeri-Tehrani, Mohammad
Aghaei Meybodi, Hamidreza
Sadat Mousavi Fakhr, Imaneh
Mahmoud Sajjadi-Jazi, Sayed
author_facet Akbari, Mojtaba
Soltani, Akbar
Reza Mohajeri-Tehrani, Mohammad
Aghaei Meybodi, Hamidreza
Sadat Mousavi Fakhr, Imaneh
Mahmoud Sajjadi-Jazi, Sayed
author_sort Akbari, Mojtaba
collection PubMed
description 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. Considering the normal imaging studies and refractory hypoglycemia to medical therapy, distal pancreatectomy was performed. The patient had no episodes of hypoglycemia after the surgery. Five months later, similar episodes recurred. Further investigations revealed different plasma concentrations of insulin and C-peptide in each hypoglycemic episode. Regarding various biochemical patterns during hypoglycemia and absence of evidence supporting other differential diagnoses, we suspected factitious causes. Close observation revealed that the patient had a history of intermittent glyburide consumption and analog insulin injection. DISCUSSION: Most commercial insulin immunoassays can only detect human insulin and lack the ability to identify synthetic analog insulin. In addition, common detection methods for sulfonylureas and meglitinides are of low diagnostic value in the human plasma and urine. These laboratory defects can lead to the misdiagnosis of insulinoma or noninsulin-mediated hypoglycemia due to the surreptitious use of insulin secretagogues or analog insulin, respectively. Therefore, due to the lack of any definitive laboratory findings, clinical suspicion is the best strategy for diagnosis.
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spelling pubmed-59611862018-05-25 Factitious Hypoglycemia Caused by a Unique Pattern of Drug Use: A Case Report Akbari, Mojtaba Soltani, Akbar Reza Mohajeri-Tehrani, Mohammad Aghaei Meybodi, Hamidreza Sadat Mousavi Fakhr, Imaneh Mahmoud Sajjadi-Jazi, Sayed Int J Endocrinol Metab Case Report 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. Considering the normal imaging studies and refractory hypoglycemia to medical therapy, distal pancreatectomy was performed. The patient had no episodes of hypoglycemia after the surgery. Five months later, similar episodes recurred. Further investigations revealed different plasma concentrations of insulin and C-peptide in each hypoglycemic episode. Regarding various biochemical patterns during hypoglycemia and absence of evidence supporting other differential diagnoses, we suspected factitious causes. Close observation revealed that the patient had a history of intermittent glyburide consumption and analog insulin injection. DISCUSSION: Most commercial insulin immunoassays can only detect human insulin and lack the ability to identify synthetic analog insulin. In addition, common detection methods for sulfonylureas and meglitinides are of low diagnostic value in the human plasma and urine. These laboratory defects can lead to the misdiagnosis of insulinoma or noninsulin-mediated hypoglycemia due to the surreptitious use of insulin secretagogues or analog insulin, respectively. Therefore, due to the lack of any definitive laboratory findings, clinical suspicion is the best strategy for diagnosis. Kowsar 2017-12-20 /pmc/articles/PMC5961186/ /pubmed/29805453 http://dx.doi.org/10.5812/ijem.62591 Text en Copyright © 2018, International Journal of Endocrinology and Metabolism http://creativecommons.org/licenses/by-nc/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/) which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.
spellingShingle Case Report
Akbari, Mojtaba
Soltani, Akbar
Reza Mohajeri-Tehrani, Mohammad
Aghaei Meybodi, Hamidreza
Sadat Mousavi Fakhr, Imaneh
Mahmoud Sajjadi-Jazi, Sayed
Factitious Hypoglycemia Caused by a Unique Pattern of Drug Use: A Case Report
title Factitious Hypoglycemia Caused by a Unique Pattern of Drug Use: A Case Report
title_full Factitious Hypoglycemia Caused by a Unique Pattern of Drug Use: A Case Report
title_fullStr Factitious Hypoglycemia Caused by a Unique Pattern of Drug Use: A Case Report
title_full_unstemmed Factitious Hypoglycemia Caused by a Unique Pattern of Drug Use: A Case Report
title_short Factitious Hypoglycemia Caused by a Unique Pattern of Drug Use: A Case Report
title_sort factitious hypoglycemia caused by a unique pattern of drug use: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5961186/
https://www.ncbi.nlm.nih.gov/pubmed/29805453
http://dx.doi.org/10.5812/ijem.62591
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