Hypoglycemia and Factitious Disorders: A Case Report and Review

Area of Science:

• Endocrinology
• Psychiatry

Background:

• Hypoglycemia presents with diverse symptoms, and its differential diagnosis includes factitious disorders involving surreptitious insulin or secretagogue use.
• Distinguishing exogenous insulin from endogenous hyperinsulinemic hypoglycemia is crucial, but sulfonylurea ingestion can mimic insulinoma findings.

Observation:

• A patient with comorbidities presented with severe hypoglycemia and altered consciousness.
• Initial labs suggested endogenous hyperinsulinism, but a serum panel detected glipizide, an unprescribed sulfonylurea.

Findings:

• The patient was diagnosed with factitious disorder, with hypoglycemia attributed to surreptitious glipizide ingestion as a healthcare-seeking behavior.
• This case underscores the diagnostic challenges in identifying iatrogenic hypoglycemia caused by factitious drug administration.

Implications:

• Accurate diagnosis of hypoglycemia is vital due to significant patient morbidity.
• Managing factitious disorder requires integrated clinical and ethical approaches, particularly concerning surreptitious medication use.