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CASE REPORT
Year : 2015  |  Volume : 20  |  Issue : 1  |  Page : 32-34

Recurrent hypoglycemia in a patient of neurofibromatosis type 1 and type 1 diabetes mellitus: Munchausen's syndrome mimicking Insulinoma


1 Department of General Medicine, Sher-I-Kashmir Institute of Medical Sciences, Medical College and Hospital, Srinagar, Jammu and Kashmir, India
2 Department of Psychiatry, Sher-I-Kashmir Institute of Medical Sciences, Medical College and Hospital, Srinagar, Jammu and Kashmir, India

Correspondence Address:
Muzafar Naik
Department of General Medicine, Sher-I-Kashmir Institute of Medical Sciences, Medical College and Hospital, Srinagar, Jammu and Kashmir
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-8990.164820

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A 35-year-old widow having neurofibromatosis type 1 (NF 1) and type 1 diabetes mellitus (DM) was admitted for abdominal pain, vomiting and recent onset low blood sugars. During hospitalization, the patient developed recurrent episodes of hypoglycemia despite stopping insulin. A possibility of insulinoma was made due to the presence of abdominal pain, vomiting, hypoglycemia, and association of insulinoma with NF 1. However, surprisingly c-peptide was very low and plasma insulin levels were high. A detailed psychiatric evaluation of the patient revealed Munchausen's syndrome as a cause of recurrent hypoglycemia. Unrecognized psychiatric illnesses in type 1 DM may lead to overzealous investigation. In conclusion, the clinical presentations of persons with factitious disorder are varied and impact every area of medicine, factitious causes should always be considered in unclarified recurrent hypoglycemia, especially in cases presented with dramatic but inconsistent medical history, and an unusual personal behavior.


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