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Annales de Biologie Clinique

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Factitious hypoglycemia : “a never-ending story”? Volume 76, issue 4, Juillet-Août 2018

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Authors
1 Département des laboratoires cliniques, Cliniques universitaires St-Luc - Université catholique de Louvain, Bruxelles, Belgique
2 Département des laboratoires cliniques, CHU – Mont-Godinne - Université catholique de Louvain, Yvoir, Belgique
3 Département d’endocrinologie et nutrition, Cliniques universitaires St-Luc - Université catholique de Louvain, Bruxelles, Belgique
4 Pôle de recherche en endocrinologie, diabète et nutrition, Institut de recherche expérimentale et clinique, Cliniques universitaires St-Luc - Université catholique de Louvain, Bruxelles, Belgique

Our team of diabetologist is challenged by the case of a 41 year-old woman with recurrent hypoglycaemic episodes. Her clinical background was complex with, among others, a neuroendocrine tumor, a nonalcoholic steatohepatitis and an adrenal insufficiency; these conditions require the exploration of several potential causes. After excluding an endogenous etiology, a factitious hypoglycemia was quicky suspected by clinicians. However, several venous samples showed normal insulinemia and a moderately decreased C-peptide. After multidisciplinary team discussion and facing a strong clinical suspicion, samples were sent to another laboratory to confirm the insulin results. Substantially supratherapeutics insulin concentrations were highlighted. This confirms the previous suspicion of surreptitious insulin administration with a recombinant form unrecognized by our routinely used analyzer. This observation leads us to briefly discuss the lack of cross-reactivities observed with many different insulin assays.