Factitious Hypoglycemia: A Tale From the Arab World

Bappal, Bhasker; George, Mark S.; Nair, Reena; Khusaiby, S. Al; Silva, V De

doi:10.1542/peds.107.1.180

Cited by 19 publications

(13 citation statements)

References 6 publications

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“…35,36 Cases of chronic surreptitious administration of insulin or antidiabetic drugs such as sulfonamides to children and adults have already been reported. [37][38][39][40][41][42][43] Nonetheless, factitious hypoglycemia continues to be misdiagnosed as PHHI, as it initially was in the 2 cases reported here. Distinguishing factitious hypoglycemia from PHHI depends on history and laboratory findings.…”

Section: Discussionmentioning

confidence: 60%

Factitious Hyperinsulinism Leading to Pancreatectomy: Severe Forms of Munchausen Syndrome by Proxy

Giurgea¹,

Ulinski

Touati³

et al. 2005

Pediatrics

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ABSTRACT. Clinical history and inappropriate insulin secretion during hypoglycemic episodes permit the diagnosis of hyperinsulinism. We report 2 cases of factitious hyperinsulinism leading to partial pancreatectomy. Case 1 was an 8-year-old girl who presented with severe hypoglycemia and elevated insulin and C-peptide levels. Catheterization of pancreatic veins was performed to localize the excess insulin secretion. Insulinoma was suspected, and partial pancreatectomy was performed. Ten days after surgery, severe hypoglycemia recurred with severely elevated plasma insulin levels (؋100) but very low C-peptide plasma levels, suggesting factitious hyperinsulinemia. Hypoglycemic episodes before surgery were provoked by oral sulfonamides; postoperative episodes were caused by parenteral insulin. Falsified prescriptions for sulfonamides and insulin by the mother, a nurse, were found. Case 2 was a 6-month-old girl who presented with seizures and hypoglycemia but had a symptom-free interval of many months afterward. At 2 years of age, repeated hypoglycemic seizures and elevated insulin plasma levels suggested congenital hyperinsulinism. C-peptide plasma level, measured once, was normal, but blood sampling was performed 15 minutes after a hypoglycemic episode. Partial pancreatectomy was performed. Two weeks after surgery, hypoglycemic seizures recurred, and the patient was admitted for pancreatic vein catheterization. This investigation was performed during hypoglycemia and revealed high insulin levels and undetectable C-peptide levels, suggesting factitious hypoglycemia. Insulin/C-peptide ratio analysis is crucial to assess factitious hypoglycemia, although sulfonamide-induced hypoglycemia is not thereby detected. P ersistent hyperinsulinemic hypoglycemia of infancy (PHHI) is a profound hypoglycemia resulting from excess insulin secretion. The diagnosis of PHHI is based on the combination of the clinical history and the laboratory findings. The clinical presentation of PHHI varies with the age at onset of hypoglycemia. The neonatal form (ϳ60% of all patients) is characterized by hypoglycemia within 72 hours after birth, with ϳ50% of the patients exhibiting seizures. Irreversible brain damage may occur. Infantile-onset PHHI (35% of patients) occurs between the 1st and the 12th months of life, and, again, seizures occur in 50% of the patients. Approximately 5% of pediatric patients with PHHI present after 1 year of age. Laboratory findings of PHHI include fasting and postprandial hypoglycemia (Ͻ3 mmol/L) with hyperinsulinemia (plasma insulin concentrations Ͼ3 mU/L) and elevated C-peptide levels, requiring high rates of intravenous glucose (Ͼ10 mg/kg/min) to maintain blood glucose Ͼ3 mmol/L. Plasma glucose concentration increases by 2 to 3 mmol/L in response to 0.5 mg of glucagon injection. In the absence of clearly abnormal insulin levels during hypoglycemia, a 4-to 6-hour fasting study may reveal inappropriately low plasma levels of ketone bodies, free fatty acids, and branched-chain amino acids.The causes of PHHI includ...

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Section: Discussionmentioning

confidence: 60%

Factitious Hyperinsulinism Leading to Pancreatectomy: Severe Forms of Munchausen Syndrome by Proxy

Giurgea¹,

Ulinski

Touati³

et al. 2005

Pediatrics

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“…One of the clinical presentations of AFD and PCF may be the induction of hypoglycemia via exogenous insulin injection or oral antidiabetics (15, 24–26). In these cases, the differentiation between exogenous and endogenous hyperinsulinism is the key to uncovering induced hyperinsulinism.…”

Section: Discussionmentioning

confidence: 99%

Pediatric condition falsification (Munchausen syndrome by Proxy) as a continuum of maternal factitious disorder (Munchausen syndrome)

2010

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Pediatric condition falsification (PCF), also known as Munchausen syndrome by Proxy or Medical Child Abuse, is a somewhat rare form of child abuse and neglect. Its association with a history of adult factitious disorder (AFD) or Munchausen syndrome in the perpetrator is also well known. Exogenous insulin injection to cause hypoglycemia both in the context of PCF and AFD has been reported in the literature. However, the coexistence of both conditions via insulin injection in the same family has not been reported in the literature. This paper presents a family, in which the mother was diagnosed with AFD and her three children with PCF perpetrated by their mother via exogenous insulin injection.

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“…5 A second paper reported factitious hypoglycaemia and a third raised the question concerning vehicle entrapment as child neglect. 6,8 In this paper, we report six cases of CM from SQUH, with the aim of highlighting the existence of the problem. In order to increase the level of awareness of this potentially devastating problem, methods of diagnosis are discussed as are the challenges faced by the child protection team in case management.…”

Section: Child Maltreatmentmentioning

confidence: 99%

“…2 Data concerning child maltreatment (CM) is scarce in Arab countries, but in recent years medical professionals of the Arabian Peninsula have recognised that CM exists, as is evident due to the increase in publications about CM in medical journals. [3][4][5][6][7][8] A study from Bahrain reported 150 cases of maltreated children, in which the mean age was 7±4 years. The majority of the children were males (53%).…”

Section: Child Maltreatmentmentioning

confidence: 99%

Child Maltreatment : Types and Effects : Series of Six Cases from a University Hospital in Oman = إساءة معاملة الأطفال : أنواعه و نتائجه : تقرير ست حالات من مستشفى جامعي في عمان

Saadoon¹,

Al-Sharbati²,

Nour³

et al. 2012

SQUMJ

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Child maltreatment (CM) is common worldwide, and can take many forms. It may even endanger the child's life, especially when younger children are the victims. CM affects the child's quality of life and consequently leads to long term issues to be dealt with by the child, family and community. This case series discusses six children who have been subjected to CM, and diagnosed by the child protection team of the departments of Child Health and Behavioural Medicine at Sultan Qaboos University Hospital (SQUH), Oman. The aim of this case series is to increase the level of awareness of CM among Oman's medical professionals and to highlight the difficulties encountered in diagnosing and providing optimal care for these children. Although treatment is provided in Oman's health care system, it is clear that there are gaps in the existing system which affect the quality of child protection services provided to the children and their families.

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Factitious Hypoglycemia: A Tale From the Arab World

Cited by 19 publications

References 6 publications

Factitious Hyperinsulinism Leading to Pancreatectomy: Severe Forms of Munchausen Syndrome by Proxy

Factitious Hyperinsulinism Leading to Pancreatectomy: Severe Forms of Munchausen Syndrome by Proxy

Pediatric condition falsification (Munchausen syndrome by Proxy) as a continuum of maternal factitious disorder (Munchausen syndrome)

Child Maltreatment : Types and Effects : Series of Six Cases from a University Hospital in Oman = إساءة معاملة الأطفال : أنواعه و نتائجه : تقرير ست حالات من مستشفى جامعي في عمان

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