Factitial illness, frustrating from both a diagnostic and therapeutic standpoint, is a well-recognized entity. Metabolic malingerers are a major subgroup, and their problems include factitial thyrotoxicosis, myxedema, and hyperinsulinism. We describe here the case of a patient who added epinephrine to a urine sample.
A 27-year-old white female nurse was seen at the Mayo Clinic in November 1977 with a referral diagnosis of pheochromocytoma. Her illness started in February 1976 when she began having recurrent "attacks" of tachycardia, anxiety, diaphoresis, and dizziness. She was hospitalized in August 1976 after 12 such episodes; elevated levels of urinary catecholamines had been found