Endocrine Abstracts

Introduction: Spontaneous hypoglycemia in non-diabetic patients is a rare metabolic emergency caused by multiple etiologies. Factitious hypoglycemia, a form of the Munchausen syndrome, is defined as the surreptitious use of insulin or oral hypoglycemic agents to deliberately induce self-harm. It is one of the most challenging diagnoses associated with significant morbidity and mortality. The aim of this study was to assess the prevalence and the associated factors of factitious hypoglycemia in non-diabetic patients.

Methods: This was a single-center, retrospective study including 70 non-diabetic patients who were admitted to our department between 2004 and 2020 for the exploration of a spontaneous hypoglycemia. All enrolled patients fulfilled the Whipple triad. Exclusion criteria were: pregnancy, severe renal failure, hepatic failure, cirrhosis, heart failure, and a history of malignant tumors. Age, gender, epidemiological parameters, medical history, clinical and paraclinical data, and the etiology of hypoglycemia were collected from medical records.

Results: The diagnosis of factitious hypoglycemia was confirmed in 11 patients (9 women and 2 men) corresponding to a prevalence of 16%. It was secondary to an intentional insulin use in 6 patients and to the ingestion of Glibenclamide in 5 patients. Their mean age was 30.27 ±13.02 years with extremes of 14 and 54 years. Two patients with factitious hypoglycemia had a personal history of psychiatric disorders. Age ≤ 35 years (Odds Ratio= 5.6,P=0.017), family history of diabetes mellitus (Odds Ratio=1.29,P=0.015), attention disorders (Odds Ratio=12.5,P=0.017), and fasting glucose level<0.7 g/l (Odds Ratio=5.75, P=0.017) were positively associated with factitious hypoglycemia.

Conclusion: Factitious hypoglycemia is more frequent in middle-aged women with psychosocial issues and a family history of diabetes mellitus explaining the ease to access to insulin and anti-diabetic agents. A psychiatric referral and a supportive follow up are warranted to provide the appropriate guidance for patients and perform an essential role in the long-term management of factitious hypoglycemia.