Endocrine Abstracts

Introduction: The Munchausen syndrome, also known as factitious disorder, involves a compulsion to simulate illness or trauma. Individuals may go as far as taking medication or inflicting harm on their bodies to evoke compassion. The aim of this report is to illustrate the example of factitious hypoglycemia, one of the most common forms of factitious disorders in the endocrine-metabolic field, accounting for 4-11% of all non-diabetic hypoglycemias.

Observation: Case 1: A young women aged 23 years old, with a personal history of polycystic ovary syndrome and endometriosis, and a family history of a husband with type 1 diabetes mellitus on insulin therapy, was admitted for investigation of multiple hypoglycemic episodes which manifested by adrenergic and neuroglycopenic signs. The clinical examination found an overweight patient, with no signs of adrenal deficiency, the presence of several bruises related to injections on both arms. During her hospital stay, she presented a spontaneous hypoglycemia at 0.34 g/l on capillary blood, confirmed by a venous test at 0.33 g/l. Additional testing performed at that time revealed an inappropriately elevated level of insulin (38 uuui/ml) and a low plasma C-peptide level (0.2 ng/ml). A qualitative serum and urinary sulfonylurea panel was negative, confirming the artificial origin of hypoglycemia. After psychological evaluation, she denied taking any glucose lowering agents, but she admitted to have taken blood thinner accidentally, which resulted in a hemorrhage. In light of these findings, a psychiatric evaluation was established which revealed an anxious, distressed patient with narcissistic personality traits. She was referred to a psychiatrist for follow-up. Case 2: 16-year-old young female, with no personal medical history, with a family history of diabetes mellitus in both her father and her maternal grandmother, treated with oral antidiabetic drugs and insulin respectively. She was admitted into the department of endocrinology to explore multiple severe hypoglycemic episodes (0.2-0.5 g/l) with adrenergic and neuroglycopenic symptoms. During her hospitalization, we did not objectify any hypoglycemic episodes on either capillary or venous tests. Oral glucose tolerance test was normal. The patient vehemently denied taking any hypoglycemic medication or having any affecting problem. After a psychological evaluation, she admitted to secretly taking insulin and oral antidiabetic drugs.

Conclusion: Factitious hypoglycemia is a real diagnostic challenge. Collaboration between endocrinologists, psychologists and psychiatrists is necessary for establishing this diagnosis and for follow-up.