Pheochromocytoma or Münchausen syndrome: the masquerade is up

Eisenhofer, Graeme

doi:10.1007/s10286-010-0067-5

Cited by 3 publications

(9 citation statements)

References 9 publications

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“…41 Consistently reported clues include dramatic presentations; inconsistent histo-ries; recurrent illnesses that worsen or change after appropriate treatment; extensive medical knowledge; knowledge of hospital systems; an eagerness for invasive procedures; claiming specific diagnoses; and attempts to dictate treatment. 30,34,37,[42][43][44][45][46][47][48][49] There may also be a previous history of Munchausen behavior, use of aliases, and peregrination. 30,34,43,50 Lack of stable relationships is common as these patients may have a history of neglect during childhood, disruptive family ties, poor interpersonal relationships, and estrangement from their families.…”

Section: Management Of Munchausen Syndromementioning

confidence: 99%

“…When emergent care is required, performing a search of the room and personal belongings without patient consent may be justifiable. 8,16,23,29,34,[42][43][44][64][65][66][67] Patient observation may be required for protection from further self-harm and to provide evidence of fabrication. This includes use of sitters or 24-hour video monitoring.…”

Section: Management Of Munchausen Syndromementioning

confidence: 99%

“…12 Many patients with Munchausen syndrome have histories of parental neglect, childhood abuse, early losses, early illness that led to prolonged medical treatment or hospitalization, recent life-stressors, poor family relationships, poor cop-ing skills, and attention and sympathy seeking in addition to repeated medical admissions at various medical centers without resolution of their symptoms. 18,23,31,32,37,38,39,42,44,45,47,53,54,59,64,75,77 Comorbid personality disorders are common. 12,34 For others, Munchausen syndrome could be a means to control others, express rage, or enhance their self-esteem as they succeed in deceiving clinicians.…”

Section: Management Of Munchausen Syndromementioning

confidence: 99%

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Munchausen Syndrome: A Review of Patient Management

Wong¹,

Detweiler²

2016

Psychiatric Annals

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The management of Munchausen syndrome is fraught with complexities related to legality, ethics, and its inherent nature. An illustrative case of factitious aortic dissection is presented as well as a review of the literature for the management Munchausen syndrome, which includes strategies reported to be effective. Management of Munchausen syndrome requires a high index of suspicion, a good history, and thorough physical examination. Objective illnesses resulting from the factitious behavior should be treated, while avoiding unnecessary procedures. Early referral to a psychiatry team is critical as this may be an empathetic and face-saving approach for the patient. Regularly scheduled appointments, not dependent on the patient's distress level, are associated with improved long-term prognosis. Patients with Munchausen syndrome can suffer considerable iatrogenic morbidity and mortality, and they place immense strain on the health care system. Physicians should be aware of the complexities of these cases, the management options, and the frequent need for psychiatry consultations [Psychiatr Ann. 2016;46(1):66-70.] M unchausen syndrome is the most severe and chronic form of factitious disorder imposed on the self, with predominantly physical signs and symptoms, pseudologia fantas-tica, and peregrination (frequent traveling from one medical center to another) that often lead to recurrent hospitalizations. It tends to have a refractory course. Munchausen syndrome is unique because it is a psychiatric disorder that most frequently presents as an apparently severe illness in the non-psychiatric setting. Even though Munchausen syndrome is studied by most clinicians in training, the first case often leaves them feeling blindsided by the patient, creating a fractured clinicianpatient rapport. Many clinicians remember their first Munchausen syndrome case as if they were seeing medicine through a distorted prism and struggle with residual conflicting thoughts, as the clinical and ethical implications can be challenging. Munchausen syndrome was first described by Dr. Richard Asher in his landmark 1951 article. 1 He had named the

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Section: Management Of Munchausen Syndromementioning

confidence: 99%

Section: Management Of Munchausen Syndromementioning

confidence: 99%

Section: Management Of Munchausen Syndromementioning

confidence: 99%

See 1 more Smart Citation

Munchausen Syndrome: A Review of Patient Management

Wong¹,

Detweiler²

2016

Psychiatric Annals

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“…26 Indeed with the transition to metanephrine analysis as a first-line investigation of phaeochromocytoma, it is likely that such sample tampering would go unnoticed and thus would not lead to diagnostic confusion. Nonetheless, it is important to ascertain if and how sample manipulation had occurred.…”

Section: Specimen Manipulation In Factitious Disordermentioning

confidence: 99%

“…However, catecholamine analysis revealing isolated epinephrine elevations would be highly unusual for a true phaeochromocytoma. 26 Catecholamines are metabolized to metanephrines within tumour cells of a phaeochromocytoma. This process occurs continuously, and independently of catecholamine release so that in phaeochromocytoma metanephrine concentrations remain high even between symptomatic episodes.…”

Section: Factitious Phaeochromocytomamentioning

confidence: 99%

Munchausen syndrome and factitious disorder: the role of the laboratory in its detection and diagnosis

2013

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The term Munchausen syndrome is used to describe the patient who chronically fabricates or induces illness with the sole intention of assuming the patient role. Such persons often have a close association with the medical profession and thus use their knowledge to falsify symptoms and laboratory specimens to mimic disease. Cases of factitious disease have appeared in the literature originating from all medical specialties, and include such rare disorders as phaeochromocytoma and Bartter's syndrome. The laboratory can play a key role in the detection and diagnosis of factitious disorders. Indeed discrepant biochemistry results may provide the first clue to the diagnosis. Laboratory staff should be particularly aware of highly variable test results and extreme abnormalities that are not consistent with the wider biochemical profile, suggesting sample tampering. Factitious disorder should also be included in the clinician's differential diagnosis when disease presentation is unusual or an underlying cause cannot be found. Investigation to exclude or confirm factitious disorder at an early stage can prevent unnecessary testing in the search for increasingly rare diseases. Appropriate analyses may include screening tests for the detection of surreptitious drug administration or replication of a fabricated sample to confirm the method used. In all cases close communication between the clinician and laboratory is essential. This will ensure that appropriate tests are conducted particularly with regard to time critical and repeat tests.

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Biochemical Assessment of Pheochromocytoma and Paraganglioma

2023

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Pheochromocytoma and paraganglioma (PPGL) require prompt consideration and efficient diagnosis and treatment to minimize associated morbidity and mortality. Once considered, appropriate biochemical testing is key to diagnosis. Advances in understanding catecholamine metabolism clarified why measurements of the O-methylated catecholamine metabolites rather than the catecholamines themselves are important for effective diagnosis. These metabolites, normetanephrine and metanephrine, produced respectively from norepinephrine and epinephrine, can be measured in plasma or urine, with choice according to available methods or presentation of patients. For patients with signs and symptoms of catecholamine excess, either test will invariably establish the diagnosis, whereas the plasma test provides higher sensitivity than urinary metanephrines for patients screened due to an incidentaloma or genetic predisposition, particularly for small tumors or in patients with an asymptomatic presentation. Additional measurements of plasma methoxytyramine can be important for some tumors, such as paragangliomas and for surveillance of patients at risk of metastatic disease. Avoidance of false-positive test results is best achieved by plasma measurements with appropriate reference intervals and preanalytical precautions, including sampling blood in the fully supine position. Follow-up of positive results, including optimization of preanalytics for repeat tests or whether to proceed directly to anatomic imaging or confirmatory clonidine tests, depends on the nature of test results, which can also suggest likely size, adrenal versus extra-adrenal location, underlying biology or even metastatic involvement of a suspected tumor. Modern biochemical testing now makes diagnosis of PPGL relatively simple. Integration of artificial intelligence into the process should make it possible to fine-tune these advances.

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Pheochromocytoma or Münchausen syndrome: the masquerade is up

Cited by 3 publications

References 9 publications

Munchausen Syndrome: A Review of Patient Management

Munchausen Syndrome: A Review of Patient Management

Munchausen syndrome and factitious disorder: the role of the laboratory in its detection and diagnosis

Biochemical Assessment of Pheochromocytoma and Paraganglioma

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