Elevated hormone levels without endocrinopathy: hypercortisoluria and hypoglycemia as facticious disorders
Kerstens, M.N.; Hoogenberg, K.; Kema, I.P.; Minkema, H.J.; Dullaart, R.P.
Nederlands Tijdschrift Voor Geneeskunde 145(13): 609-612
2001
ISSN/ISBN: 0028-2162 PMID: 11305207 Document Number: 528969
A 29-year-old female patient with weight gain and intermittent hypertension was suspected of having Cushing's syndrome due to conspicuous hypercortisoluria. Specific laboratory tests demonstrated that the urine samples contained prednisolone, which had resulted in a false positive elevation of urine-free cortisol measurements. The patient admitted to having taken prednisolone tablets and also to having added them to several urine collections. In a 21-year-old male patient with unexplained hypoglycaemia, hypoglycaemia was recorded during a 72-hour fast together with an elevated level of plasma insulin and a low level of plasma C-peptide. The presence of insulin autoantibodies could be excluded, making a diagnosis of factitious hypoglycaemia highly likely. Both patients were confronted with the factitious disorder and received psychiatric counselling, after which no further problems arose. Where excessive hormone levels occur, the possibility of a factitious disorder needs to be considered. In such cases, specific supplementary laboratory tests may prove helpful.