Importance of Insulin Immunoassays in the Diagnosis of Factitious Hypoglycemia

Elmas O. N., DEMİR K., SOYLU N., Celik N., Ozkan B.

JOURNAL OF CLINICAL RESEARCH IN PEDIATRIC ENDOCRINOLOGY, cilt.6, sa.4, ss.258-261, 2014 (SCI-Expanded) identifier

  • Yayın Türü: Makale / Tam Makale
  • Cilt numarası: 6 Sayı: 4
  • Basım Tarihi: 2014
  • Doi Numarası: 10.4274/jcrpe.1492
  • Dergi Adı: JOURNAL OF CLINICAL RESEARCH IN PEDIATRIC ENDOCRINOLOGY
  • Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Sayfa Sayıları: ss.258-261
  • Anahtar Kelimeler: Type 1 diabetes mellitus, DIDMOAD, factitious hypoglycemia, recurrent hypoglycemia, insulin assay, CROSS-REACTIVITY, ANALOGS, MISUSE
  • İstanbul Üniversitesi Adresli: Hayır

Özet

We report two cases emphasizing the importance of insulin assays for evaluation of hypoglycemia in diabetic patients. Case 1 was a 9(6/12)-year-old female patient with type 1 diabetes mellitus and case 2 was a 10(10/12)-year-old male patient with DIDMOAD. Both patients were on a basal-bolus insulin regimen. Both were admitted because of persistent hypoglycemia. Analyses of serum samples obtained at the time of hypoglycemia initially showed low insulin and C-peptide levels. Recurrent episodes of unexplained hypoglycemia necessitated measurement of insulin levels by using different insulin assays, which revealed hyperinsulinemic hypoglycemia with low C-peptide levels, findings which confirmed a diagnosis of factitious hypoglycemia. Surreptitious administration of insulin should not be excluded in diabetic patients with hypoglycemia without taking into account the rate of cross-reactivity of insulin analogues with the insulin assay used.