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Plasma C-Peptide and Diagnosis of Factitious Hyperinsulinism
Study of an Insulin-Dependent Diabetic Patient with "Spontaneous" Hypoglycemia
- CHAIYAPON COUROPMITREE, M.D.;
- NORBERT FREINKEL, M.D., F.A.C.P.;
- THEODORE C. NAGEL, M.D.;
- DAVID L. HORWITZ, M.D.;
- BOYD METZGER, M.D.;
- ARTHUR H. RUBENSTEIN, M.D., F.A.C.P.; and
- ROBERT HAHNEL, M.D.
Abstract
Factitious hyperinsulinism was suspected in a patient with an 11-year history of insulin-dependent, ketosis-prone diabetes mellitus who began to experience repetitive episodes of "spontaneous" hypoglycemia. Insulin mediation of the hypoglycemia was confirmed by documenting that urinary insulin and total extractable insulin in plasma increased during periods of hypoglycemia. Failure to detect significant amounts of human C-peptide by radioimmunoassay during periods of hypoglycemia or in response to stimulation with glucagon, leucine, or tolbutamide indicated that the insulin was not endogenous. The diagnosis of factitious hyperinsulinism was ultimately proved by the finding of radioactivity in the patient's urine after 131I Hippuran® was added to a vial of insulin found in the patient's room.
Article and Author Information
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▸From the Center for Endocrinology, Metabolism, and Nutrition, Departments of Medicine and Biochemistry, Northwestern University Medical School; and the Department of Medicine, University of Chicago, Pritzker School of Medicine; Chicago, Illinois.
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▸Requests for reprints should be addressed to Norbert Freinkel, M.D., Center for Endocrinology, Metabolism, and Nutrition, Northwestern University Medical School, 303 East Chicago Ave., Chicago, IL 60611.
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- Received May 6, 1974.
- Accepted September 24, 1974.
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