Factitious Hypoglycemia in an Infant With Undetectable Exogenous Insulin by a Commercial Insulin Immunoassay: A Diagnostic Pitfall

Factitious hypoglycemia in infancy is a rare, life-threatening manifestation of Munchausen syndrome by proxy (MSBP). The hallmark of such presentation is the detection of low c-peptide combined with high insulin at the time of hypoglycemia. We report the case of a male infant who presented with recu...

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Bibliographic Details
Published in:Curēus (Palo Alto, CA) CA), 2023-01, Vol.15 (1), p.e33224
Main Authors: Arabi, Hisham, Babiker, Amir, Awadalla, Asma M, Ababneh, Faroug, AlMuneef, Maha A
Format: Article
Language:English
Subjects:
Caregivers
Case reports
Child abuse & neglect
Convulsions & seizures
Diabetes
Domestic violence
Endocrinology/Diabetes/Metabolism
Enteral nutrition
Gastroesophageal reflux
Glucose
Hospitals
Hypoglycemia
Immunoassay
Insulin
Intensive care
Laboratories
Medical diagnosis
Mental disorders
Mental health
Metabolism
Ostomy
Patient admissions
Pediatrics
Peptides
Siblings
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Summary:Factitious hypoglycemia in infancy is a rare, life-threatening manifestation of Munchausen syndrome by proxy (MSBP). The hallmark of such presentation is the detection of low c-peptide combined with high insulin at the time of hypoglycemia. We report the case of a male infant who presented with recurrent severe unexplained hypoglycemic episodes since the age of six months. Two of his siblings had similar unexplained hypoglycemia episodes at a young age. He was extensively investigated, and all were normal, for endocrine and metabolic etiologies. He underwent fundoplication and insertion of a gastrostomy tube with multiple lengthy hospital admissions. His mother had diabetes and was on insulin treatment; she also had mental health issues with family-related social stressors. His hypoglycemic attacks resolved once separated briefly from his mother on the ward, raising our suspicion of MSBP. The exogenous administration of insulin was only confirmed following a scheduled change of our local Insulin assay in our laboratory when his insulin was detectable with low C-peptide on one of his typical attacks. Apparently, our previous insulin immunoassay lacked sensitivity for his mother's long-acting insulin. We are reporting this case to raise awareness about this potential diagnostic pitfall.
ISSN:2168-8184
2168-8184
DOI:10.7759/cureus.33224