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[Factitious insulinoma]

M C Blans1, J M Conemans, J K van der Veer

  • 1Bosch Medicentrum, afd. Inwendige Geneeskunde, 's-Hertogenbosch.

Nederlands Tijdschrift Voor Geneeskunde
|December 18, 1998
PubMed
Summary

Recurrent hypoglycemia in a patient suspected of insulinoma was found to be caused by sulfonylurea abuse. This highlights the importance of considering drug-induced hypoglycemia when tumors are undetectable.

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Area of Science:

  • Endocrinology
  • Clinical Toxicology

Background:

  • Recurrent hypoglycemia can be a diagnostic challenge, often initially investigated as an insulinoma.
  • Factitious disorders can present with complex medical symptoms, complicating diagnosis.

Observation:

  • A 32-year-old woman presented with recurrent hypoglycemia, high insulin, and C-peptide levels, initially suggesting an insulinoma.
  • Despite thorough imaging, no pancreatic tumor was found, and the patient had significant psychological issues.
  • High insulin and C-peptide levels, coupled with a psychiatric disorder, raised suspicion of sulfonylurea derivative abuse.

Findings:

  • Toxicological screening confirmed the patient's abuse of sulfonylurea derivatives.
  • The case demonstrates that sulfonylurea abuse can mimic endogenous hyperinsulinism.

Implications:

  • Unexplained hypoglycemia, particularly when an insulinoma is not detected, warrants suspicion of surreptitious sulfonylurea use.
  • Integrated diagnostic approaches combining biochemical, imaging, and toxicological assessments are crucial.
  • Recognition of factitious disorders is vital in managing complex medical presentations.

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