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Hipoglicémia factícia : a propósito de um caso clínico
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A hipoglicémia factícia é uma perturbação psiquiátrica na qual o doente manipula a glicémia através da administração de insulina ou de fármacos secratogogos com o objetivo de estar doente.
Deu entrada no serviço de Medicina IV do Hospital Fernando Fonseca, uma mulher de 49 anos com história de diversos internamentos prévios (que incluíram uma pancreatectomia corpo-caudal, uma duodenopancreatectomia cefálica e um transplante bilateral de córnea) e que esteve internada durante cerca de 1 mês por hipoglicémias recorrentes. No final deste período a equipa médica excluiu que existisse patologia orgânica que explicasse esta situação, surgindo como hipótese de diagnóstico: a perturbação factícia.
O diagnóstico de perturbação factícia induzida pela insulina, requer uma estreita colaboração entre a endocrinologia e a patologia clínica. E pode culminar na morte, se o diagnóstico não for atempado.
Além do caso clínico, este trabalho aborda as causas de hipoglicémia, aspetos metodológicos das análises que detetam os diferentes análogos da insulina, o Síndrome de Münchhausen, e ainda a perturbação factícia em geral.
Para tal fez-se uma revisão da bibliografia através da pesquisa da expressão “factitious hypoglycemia” e “factitious disorder” nas bases de dados PubMed, PsycInfo, Gale Academic OneFile e Uptodate.
Este trabalho pretende sensibilizar a comunidade médica sobre situações semelhantes, em que os doentes evidenciam um sofrimento psíquico considerado, camuflado na pertubação factícia, que procuram, inconscientemente, a atenção dos profissionais de saúde.
Apesar de esta doença psiquiátrica ter uma prevalência de cerca de 1% nos doentes internados, é um diagnóstico que pode confundir os médicos numa abordagem inicial, sendo necessária uma abordagem psicossocial.
Factitious hypoglycemia is a psychiatric disorder in which the patient manipulates blood glucose by administering insulin or insulin secretagogues with the aim of assuming the sick role. Our team was challenged by the case of a 49-year-old woman with a history of several previous hospitalizations (which included a distal pancreatectomy, a cephalic duodenopancreatectomy and a bilateral corneal transplantation). She was admitted to the medicine ward, were she stayed a month with recurrent hypoglycaemic episodes. Our team ruled out the existence of any organic pathology that could explain her condition, factitious disorder emerged as a diagnostic hypothesis. The diagnosis of insulin-induced factitious disorder requires a close collaboration between internists and clinical pathologists. And can lead to coma, or even death, if there isn’t caught early. This work also addresses the potential causes of hypoglycemia, limitations of the insulin assays in detecting surreptitious or malicious exogenous insulin preparations, Münchhausen syndrome and factitious disorder in general. The author searched the PubMed, PsycInfo, Gale Academic OneFile, and Uptodate databases for “factitious hypoglycemia” and “factitious disorder”. This paper aims to raise awareness about similar cases, in which the patients are seeking attention. Although this psychiatric disease has a prevalence of circa 1% this diagnosis be difficult in an initial approach, which shows the importance of early recognition of factitious hypoglycemia.
Factitious hypoglycemia is a psychiatric disorder in which the patient manipulates blood glucose by administering insulin or insulin secretagogues with the aim of assuming the sick role. Our team was challenged by the case of a 49-year-old woman with a history of several previous hospitalizations (which included a distal pancreatectomy, a cephalic duodenopancreatectomy and a bilateral corneal transplantation). She was admitted to the medicine ward, were she stayed a month with recurrent hypoglycaemic episodes. Our team ruled out the existence of any organic pathology that could explain her condition, factitious disorder emerged as a diagnostic hypothesis. The diagnosis of insulin-induced factitious disorder requires a close collaboration between internists and clinical pathologists. And can lead to coma, or even death, if there isn’t caught early. This work also addresses the potential causes of hypoglycemia, limitations of the insulin assays in detecting surreptitious or malicious exogenous insulin preparations, Münchhausen syndrome and factitious disorder in general. The author searched the PubMed, PsycInfo, Gale Academic OneFile, and Uptodate databases for “factitious hypoglycemia” and “factitious disorder”. This paper aims to raise awareness about similar cases, in which the patients are seeking attention. Although this psychiatric disease has a prevalence of circa 1% this diagnosis be difficult in an initial approach, which shows the importance of early recognition of factitious hypoglycemia.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2021
Palavras-chave
Hipoglicémia factícia Perturbação factícia Síndrome de Münchhausen