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[Elevated hormone levels without endocrinopathy: hypercortisoluria and hypoglycemia as facticious disorders]
M N Kerstens1, K Hoogenberg, I P Kema
1Afd. Endocrinologie, Academisch Ziekenhuis, Postbus 30.001, 9700 RB Groningen. m.n.kerstens@int.azg.nl
Nederlands Tijdschrift Voor Geneeskunde
|April 18, 2001
Summary
Factitious disorders can mimic endocrine diseases. In two cases, patients self-administered hormones, causing misleading lab results for Cushing's syndrome and hypoglycemia. Psychiatric counseling resolved the issues.
Area of Science:
- Endocrinology
- Clinical Chemistry
- Psychiatry
Background:
- Factitious disorders, where patients intentionally produce or feign physical or psychological symptoms, can present diagnostic challenges in endocrinology.
- Misleading laboratory results due to self-administration of hormones can mimic genuine endocrine conditions, complicating diagnosis and treatment.
Observation:
- A female patient with symptoms of Cushing's syndrome showed elevated urine-free cortisol due to prednisolone ingestion and sample adulteration.
- A male patient with unexplained hypoglycemia had elevated insulin and low C-peptide, suggestive of factitious hypoglycemia after excluding insulin autoantibodies.
Findings:
- Specific laboratory tests identified prednisolone in urine, revealing factitious hypercortisoluria.
- Exclusion of insulin autoantibodies in the context of hypoglycemia and abnormal hormone levels pointed towards factitious hypoglycemia.
Implications:
- Clinicians should consider factitious disorders when hormone levels are excessively high or inconsistent with clinical presentation.
- Supplementary laboratory testing and careful patient history are crucial for diagnosing factitious endocrine disorders.
- Prompt diagnosis and psychiatric intervention can lead to successful resolution of factitious disorders.