[Factitious hypoglycemia: clinical aspects, diagnosis and course in a non-diabetic male]

The case of a 37-year-old man without diabetes is reported who began to experience repetitive episodes of loss of consciousness. For 11/2 years the patient suffered from attacks of fatigue associated with sweating, tachycardia, blurred vision and finally unconsciousness. In the presence of low blood sugar and high plasma insulin values, an insulin producing pancreatic adenoma was initially suspected. In view of the negative results of radiological investigations, the different blood sugar reactions during fasting tests with and without supervision, together with low concentrations of C-peptide and high insulin values during various hypoglycemic episodes, factitious hypoglycemia was diagnosed. Finally, an ampoule of insulin was found in a locked suitcase of the patient. Therefore, in patients with fasting hypoglycemia as well as insulin producing adenoma, surreptitious insulin injections as part of a Müncchausen syndrome should be considered.