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

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AKBARI MOJTABA; SOLTANI AKBAR; MOHAJERI TEHRANI MOHAMMAD REZA; AGHAEI MEYBODI HAMIDREZA; Mousavi Fakhr Imaneh Sadat; Sajjadi Jazi Sayed Mahmoud

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Journal: International Journal of Endocrinology and Metabolism Year:2018 | Volume:16 | Issue:1 Page(s): 0-0

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Title

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

Author(s)

Keywords

Factitious

Hypoglycemia

Insulin

Glyburide

Abstract

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. Fivemonthslater, similar episodes recurred. Further investigations revealed different plasma concentrations of Insulinand 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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APA: Copy

AKBARI, MOJTABA, SOLTANI, AKBAR, MOHAJERI TEHRANI, MOHAMMAD REZA, AGHAEI MEYBODI, HAMIDREZA, Mousavi Fakhr, Imaneh Sadat, & Sajjadi Jazi, Sayed Mahmoud. (2018). Factitious Hypoglycemia Caused by a Unique Pattern of Drug Use: A Case Report. INTERNATIONAL JOURNAL OF ENDOCRINOLOGY AND METABOLISM (IJEM), 16(1), 0-0. SID. https://sid.ir/paper/753438/en

Vancouver: Copy

AKBARI MOJTABA, SOLTANI AKBAR, MOHAJERI TEHRANI MOHAMMAD REZA, AGHAEI MEYBODI HAMIDREZA, Mousavi Fakhr Imaneh Sadat, Sajjadi Jazi Sayed Mahmoud. Factitious Hypoglycemia Caused by a Unique Pattern of Drug Use: A Case Report. INTERNATIONAL JOURNAL OF ENDOCRINOLOGY AND METABOLISM (IJEM)[Internet]. 2018;16(1):0-0. Available from: https://sid.ir/paper/753438/en

IEEE: Copy

MOJTABA AKBARI, AKBAR SOLTANI, MOHAMMAD REZA MOHAJERI TEHRANI, HAMIDREZA AGHAEI MEYBODI, Imaneh Sadat Mousavi Fakhr, and Sayed Mahmoud Sajjadi Jazi, “Factitious Hypoglycemia Caused by a Unique Pattern of Drug Use: A Case Report,” INTERNATIONAL JOURNAL OF ENDOCRINOLOGY AND METABOLISM (IJEM), vol. 16, no. 1, pp. 0–0, 2018, [Online]. Available: https://sid.ir/paper/753438/en

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