Endocrine Abstracts

Introduction: Factitious hypoglycaemia in adults is usually due to exogenous intake of insulin or hypoglycaemia sulfonamides. This occult intake is most often voluntary and the diagnosis is not always obvious.

Observation: We report the case of a 37-year-old pregnant woman at 15 weeks of amenorrhoea, followed for addisson’s disease since 3 years and not diabetic, was referred to our department for acute adrenal insufficiency following the discontinuation of her replacement therapy for more than 3 months. The main symptoms were asthenia, vomiting, abdominal pain and recurrent hypoglycaemia. She was treated with intravenous high-dose hydrocortisone, with improvement of the symptoms except for randomly scheduled hypoglycaemia resistant to correction.She denied taking any medication other than those given by the nurses and the hypoglycemia continued. Investigations such as plasma measurements of insulinemia, C-peptide, hypoglycaemia sulfonamides were done concomitantly as a venous glycemia at 0.4 g/l and were respectively 87.81 μIU/ml (normal: 2.6–24.9), 8.59 ng/ml (normal: 1.1–4.4) and 135 μg/ml. The diagnosis of factitious hypoglycemia by taking sulfonamides was confirmed. The day before and during hospitalization, the patient had admitted to sneaking glibenclamide tablets and the drug was seized.

Conclusion: Factitious hypoglycaemia represents a challenge for the clinician, on the one hand the patient tries to hide certain proofs on the other hand it remains an elimination diagnosis, especially if an organic cause is preexisting as it is in our observation.