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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.
[+] Article and Author Information

▸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.


Chicago, Illinois


Ann Intern Med. 1975;82(2):201-204. doi:10.7326/0003-4819-82-2-201
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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.

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