Hyperinsulinism as evidence of munchausen syndrome by proxy: A case report

Abstract

IntroductionHyperinsulinism is one of the most important causes of hypoglycemia. Rarely, drug toxicity can be a reason. In the context of Munchausen syndrome by proxy (MSBP), toxicity usually occurs in children due to drug administration by a parent or caregiver.Methodswe report a case of a 2-year-old girl with hyperinsulinaemic hypoglycaemia due to insulin injections by her mother.Case reportMrs. W. is a 28-year-old mother of three children. In her medical history, she was diagnosed with gestational diabetes and treated briefly with insulin. She was hospitalized several times for hypoglycemia and she was diagnosed with factitious disorder. Lately, her youngest daughter aged 2 years old was hospitalized in the pediatric department for repeated unexplained loss of consciousness. The hospitalization lasted 2 months with recurrence of severe hypoglycemia. A full metabolic screen revealed no abnormalities. The mood of the mother appeared quite discordant with the situation. Strict monitoring of maternal behavior showed that the mother gives insulin injections to her daughter. She denied deliberately injecting insulin, and then she accused the health workers. She was referred to our psychiatric department and we diagnosed the MSBP.ConclusionMSBP should be considered particularly in patients who have been evaluated by more than one hospital and have discordant test results.Disclosure of interestThe authors have not supplied their declaration of competing interest.