Munchausen Syndrome-Induced Hypoglycemia Following Successful Partial Pancreatectomy for Insulinoma: Diagnostic Challenges in Hypoglycemia Management

Introduction: Hypoglycemia is rare in individuals without diabetes.One cause of hyperinsulinemic hypoglycemia is insulinoma, a rare but serious condition.Careful evaluation is essential to exclude other causes, including factitious hypoglycemia, which involves the intentional induction of low blood glucose levels without any apparent external gain, primarily to seek medical attention.Munchausen syndrome is a severe form of factitious disorder and presents a diagnostic challenge. Case Presentation:We report a case of a female patient who, at age 14, began experiencing signs and symptoms of hypoglycemia that worsened over time.At age 27, she was admitted to the emergency room following a seizure due to a hypoglycemic episode and was initially evaluated for hyperinsulinemic hypoglycemia caused by insulinoma.Surgical intervention with distal pancreatectomy improved her symptoms.However, 2-3 weeks post-surgery, she experienced recurrent hypoglycemic episodes.After an extensive investigation over ten months as an inpatient receiving continuous intravenous glucose infusion, factitious hypoglycemia was suspected and ultimately confirmed. Conclusion:This case highlights the importance of a thorough diagnostic evaluation to prevent unnecessary invasive procedures.To our knowledge, no similar case has been reported.When factitious disorder is suspected, a psychiatric evaluation is crucial.Long-term follow-up with family support and a multidisciplinary team is essential for effective management.