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Factitious hyperinsulinemic hypoglycemia: confirmation of the diagnosis by a species-specific insulin radioimmunoassay

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Abstract

Surreptitious self-administration of insulin is an important cause of hypoglycemia. A 28-year-old female hospital ward clerk presented with hypoglycemia associated with an elevated plasma insulin level and a low plasma C-peptide concentration. Factitious illness was denied by the patient until it was definitively proven by using a species-specific insulin radioimmunoassay that the type of insulin circulating at the time of hypoglycemia was of animal rather than of human origin. The differential diagnosis of hypoglycemia associated with hyperinsulinemia and the current laboratory methods which may be employed to distinguish between factitious hypoglycemia and endogenous hyperinsulinism are discussed.

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References

  1. Reich P., Gottfried L.A. Factitious disorders in a teaching hospital. Ann. Intern. Med. 99: 240, 1983.

    Article  PubMed  CAS  Google Scholar 

  2. Fajans S.S., Vinik A.I. Diagnosis and treatment of “insulinoma”. In: Santen R.J., Manni A. (Eds.), Diagnosis and management of endocrine-related tumors. Martinus Nijhoff Publishers, Boston, 1984, p. 235.

    Chapter  Google Scholar 

  3. Walfish P.G. Hypoglycemia. In: Spittel J.C. (Ed.), Clinical medicine. J.B. Lippincott, Philadelphia, 1982, p. 1.

    Google Scholar 

  4. Bauman W.A., Yalow R.S. Differential diagnosis between endogenous and exogenous insulin induced refractory hypoglycemia in a non-diabetic patient. N. Engl. J. Med. 303: 198, 1980.

    Article  PubMed  CAS  Google Scholar 

  5. Bauman W.A., Yalow R.S. Hyperinsulinemic hypoglycemia. Differential diagnosis by determination of the species of circulating insulin. JAMA 253: 2730, 1984.

    Article  Google Scholar 

  6. Walfish P.G., Kashyap R., Greenstein S. Sulfonylurea-induced factitious hypoglycemia in a non-diabetic nurse. Can. Med. Assoc. J. 112: 71, 1975.

    PubMed Central  PubMed  CAS  Google Scholar 

  7. Scarlett J.A., Mako M.E., Rubenstein A.H., Blex P.M., Goldman J., Horwitz D.L., Tager H., Jaspan J.B., Stjernholm M.R., Olefsky J.M. Factitious hypoglycemia. Diagnosis by measurement of serum C-peptide, immunoreactivity and insulin-binding antibodies. N. Engl. J. Med. 297: 1029, 1977.

    Article  PubMed  CAS  Google Scholar 

  8. Palmer J.P., Asplin C.M., Demons P., Lyen K., Tatpati D., Raghu P.K., Paquette T.L. Insulin antibodies in insulin-dependent diabetes before insulin treatment. Science 222: 1337, 1983.

    Article  PubMed  CAS  Google Scholar 

  9. Klein R.F., Seino S., Sanz N., Nolte M.S., Vinik A.I., Karam J.H. High performance liquid chromatography used to distinguish the autoimmune syndrome from factitious hypoglycemia. J. Clin. Endocrinol. Metab. 61: 571, 1985.

    Article  PubMed  CAS  Google Scholar 

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Walfish, P.G., Feig, D.S. & Bauman, W.A. Factitious hyperinsulinemic hypoglycemia: confirmation of the diagnosis by a species-specific insulin radioimmunoassay. J Endocrinol Invest 10, 601–604 (1987). https://doi.org/10.1007/BF03347007

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