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2018 | 1 | 1 | 70-75
Article title

Who stole the sugar? Recurrent hypoglycemia in three women

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This article presents 3 cases that highlight one of the factitious disorders named Munchausen Syndrome (MS). It is defined as intentional simulation or self-induction of disease symptoms to gain attention of others and to be perceived as an ill person. Early recognition of factitious disorders is a challenge for non-psychiatrists, as its clinical symptoms vary significantly among patients. In this paper we present three women with recurrent episodes of hypoglycemia, who were eventually diagnosed with MS. Our aims were to share the diagnostic clues that can suggest the presence of a factitious disorder, to highlight the analysis of patient’s medical history and to suggest the potential the ethical dilemmas involved in caring for such patients.
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  • Criddle L. Monsters in the closet: Munchausen syndrome by proxy. Crit Care Nurse. 2010;30(6):46–55.
  • Yates GP, Feldman MD. Factitious disorder: a systematic review of 455 cases in the professional literature. Gen Hosp Psychiatry. 2016;41: 20–8.
  • Turner J, Reid S. Munchausen’s syndrome. Lancet. 2002;359(9303):346–9.
  • Sutherland AJ, Rodin GM. Factitious disorders in a general hospital setting: clinical features and a review of the literature. Psychosomatics. 1990;31(4):392–9.
  • Ruiz P, Sadock V, Sadock B. Kaplan and Sadock’s Synopsis of Psychiatry: Behavioral Sciences/Clinical Psychiatry. 2014;.
  • Asher R. Münchhausen syndrome. Lancet. 1951;1(6650):339–41.
  • Little A, Curtis H, Kellogg B, Harrington M. Munchausen Syndrome Disguised As Gossypiboma: An Interesting Case. Eplasty. 2016;16:ic39.
  • Repper J. Munchausen syndrome by proxy in health care workers. J Adv Nurs. 1995;21(2):299–304.
  • Stoudemire A, Levenson JL. Clinical Psychiatry for Medical Students. Lippincott-Raven New York; 1998.
  • De Leo S, Lee SY, Braverman LE. Hyperthyroidism. Lancet. 2016;388(10047):906–18.
  • Kailasam MT, Parmer RJ, Stone RA, Shankel S, Kennedy BP, Ziegler MG, et al. Factitious pheochromocytoma: novel mimickry by Valsalva maneuver and clues to diagnosis. Am J Hypertens. 1995;8(6):651–5.
  • Chidakel AR, Pacak K, Eisenhofer G, Lawrence JE, Ayala AR. Utility of plasma free metanephrines in diagnosis of factitious pheochromocytoma. Endocr Pract. 2006;12(5):568–71.
  • Sharma ST, Nieman LK. Cushing’s syndrome: all variants, detection, and treatment. Endocrinol Metab Clin North Am. 2011;40(2):379–91.
  • Findling JW, Raff H. Diagnosis of endocrine disease: differentiation of pathologic/neoplastic hypercortisolism (Cushing’s syndrome) from physiologic/non-neoplastic hypercortisolism (formerly known as pseudo-Cushing’s syndrome). Eur J Endocrinol. 2017;176(5):R205–16.
  • Ameh V, Speak N. Factitious hypoglycaemia in a nondiabetic patient. Eur J Emerg Med. 2008;15(1):59–60.
  • Anderson B, Nostedt J, Girgis S, Dixon T, Agrawal V, Wiebe E, et al. Insulinoma or non-insulinoma pancreatogenous hypoglycemia? A diagnostic dilemma. J Surg Case Reports. 2016;2016(11):rjw188-rjw188.
  • Vella A. Postprandial (reactive) hypoglycemia [Internet]. [cited 2016 Oct 20]. Available from:
  • Kronenberg HM. Williams textbook of endocrinology. Philadelphia: Saunders Elsevier; 2007.
  • Valli V, Blandamura S, Pastorelli D, Merigliano S, Sperti C. Nesidioblastosis coexisting with non-functioning islet cell tumour in an adult. Endokrynol Pol. 2015;66(4):356–60.
  • Wong SL, Priestman A, Holmes DT. Recurrent hypoglycemia from insulin autoimmune syndrome. J Gen Intern Med. 2014;29(1):250–4.
  • Nonislet cell tumor hypoglycemia [Internet]. [cited 2018 Sep 24]. Available from:
  • Jeon JY, Kim SR, Kim HJ, Kim DJ, Lee K-W, Lee J-D, et al. Risk factors of severe hypoglycemia requiring medical assistance and neurological sequelae in patients with diabetes: A case – control study. Medicine (Baltimore). 2016;95(47):e5365.
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