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[Factitious hypoglycemia : "a never-ending story"?]
Jean-Louis Bayart1, Mélanie Closset2, Alexandra Coulon3
1Département des laboratoires cliniques, Cliniques universitaires St-Luc - Université catholique de Louvain, Bruxelles, Belgique.
Annales De Biologie Clinique
|July 12, 2018
Summary
A patient experienced recurrent hypoglycemia due to surreptitious administration of an unrecognized recombinant insulin. Standard assays failed to detect the insulin, highlighting a critical diagnostic challenge.
Area of Science:
- Endocrinology
- Clinical Diagnostics
Background:
- A 41-year-old woman with a complex medical history including neuroendocrine tumor, nonalcoholic steatohepatitis, and adrenal insufficiency presented with recurrent hypoglycemic episodes.
- Initial investigations excluded endogenous causes, leading to suspicion of factitious hypoglycemia.
Observation:
- Venous samples initially showed normal insulin levels and moderately decreased C-peptide, complicating diagnosis.
- Despite initial results, strong clinical suspicion prompted re-testing at an external laboratory.
Findings:
- External laboratory analysis revealed substantially supratherapeutic insulin concentrations.
- This confirmed surreptitious administration of a recombinant insulin form not recognized by the standard laboratory analyzer.
Implications:
- Highlights the potential for diagnostic errors with unrecognized recombinant insulin formulations.
- Underscores the importance of considering assay cross-reactivity limitations in complex hypoglycemia cases.
- Suggests the need for broader diagnostic strategies when factitious hypoglycemia is suspected.