Kleine-Levin and Munchausen syndromes in a patient with recurrent acromegaly.
Hypothalamic disease often affects the patients' personality and this also applies to pituitary tumors with suprasellar extension. We report on a patient with a 12-year history of recurrent acromegaly, treated with three transphenoidal operations, single field radiation therapy and bromocriptine/octreotide administration. During the course of follow-up she presented with self-inflicted anemia and Kleine-Levin syndrome (hypersomnia, hyperphagia and hypersexuality). Furthermore, she developed post-radiation necrosis within the right temporal lobe. Whether her neurological and personality disorders result - at least partially - from the acromegaly or the temporal lobe necrosis remains unclear. (+info)
Munchausen's syndrome: a case report.
Munchausen syndrome, a chronic factitious disorder with physical symptoms, also called hospital hoboes or hospital addiction, is an uncommon psychiatric disorder, usually presents as an emergency. The correct recognition of the syndrome is important in medical practice. A brief review with an interesting case report is presented. (+info)
Cost to National Health Service of social outcasts with organic disease.
The hospital medical records of a patient with chronic lung disease and intractable social problems have been analysed. Multiple admissions resulted in the patient spending nearly three years out of seven and a quarter years in Edinburgh hospitals and in the performance of repeated and ofter unnecessary medical investigations. Such patients are a source of considerable uneconomic expense to the National Health Service, but at present it is difficult to see how their medical and social demands can be met in any other way. (+info)
Self-inoculation with milk as a cause of recurrent cellulitis.
A 21-year-old patient had six admissions to hospital for recurrent cellulitis over a 6-month period. She underwent extensive investigations, which failed to reveal any underlying predisposing factors. On the final admission she admitted to injecting herself subcutaneously with milk to induce the lesion. Self-inoculation with foreign material must be considered in patients presenting with recurrent cellulitis. (+info)
Bacteremia due to three Bacillus species in a case of Munchausen's syndrome.
We report on a case of recurrent bacteremia due to three Bacillus spp. in an immunocompetent patient with no history of intravenous drug use. The source of the organisms was postulated to be a self-injected compound containing Bacillus spores, given the patient's past history of psychiatric illness and self-destructive behavior. (+info)
Identification and quantification of 8 sulfonylureas with clinical toxicology interest by liquid chromatography-ion-trap tandem mass spectrometry and library searching.
BACKGROUND: Identification of sulfonylureas in blood may be useful in the evaluation of hypoglycemic crises of unknown origin. The aim of the present study was to develop a highly selective liquid chromatography-electrospray tandem mass spectrometry (MS-MS) method using an ion-trap detector for rapid screening, identification, and quantification of sulfonylureas in human plasma. METHODS: After standard liquid-liquid extraction with glisoxepide as an internal standard, 8 sulfonylureas (glibenclamide, glipizide, gliclazide, glibornuride, glimepiride, carbutamide, chlorpropamide, and tolbutamide) were eluted from a C18 column within 10 min with an isocratic mobile phase. Drugs were identified and quantified in full-scan MS-MS mode by use of a homemade MS-MS library. We used the assay in 134 cases of hypoglycemic crises of unknown origin. RESULTS: No ion suppression effect was noted for the analytes at their specific retention-time windows. For all drugs, assay validation showed good linearity (r2>0.990) and acceptable imprecision and recovery based on commonly used criteria of acceptance. The mean extraction recoveries were 63%-87% for 5 sulfonylureas but <45% for 3 (carbutamide, chlorpropamide, and tolbutamide). Nevertheless, the high sensitivity of the MS instrument made possible detection and quantification of all 8 drugs at subtherapeutic to toxic concentrations with good precision. Sulfonylureas were found in 9 hypoglycemic patients. CONCLUSION: The described assay method allows accurate, rapid identification and quantification of 8 sulfonylureas in human plasma and can be used for specific diagnosis of factitious hypoglycemia caused by ingestion of these drugs. (+info)
Factitious hyperamylasuria by a nurse: symptom of Munchausen's syndrome.
A 30-year-old nurse presented with abdominal pain and tenderness. Her blood tests, including amylase, were normal. Urinary amylase was extremely high. The source of the increased urinary amylase was found to be the patient's saliva - she had spit into her urine sample. Subsequent investigation showed that she had Munchausen's syndrome. (+info)
Clear otorrhea: a case of Munchausen syndrome in a pediatric patient.
This paper reports a case of Munchausen syndrome in a pediatric patient. An 11-year-old girl presented with the complaint of clear fluid otorrhea. She underwent numerous investigations with deception of the physicians. The literature with respect to Munchausen syndrome in the pediatric patient is reviewed. Diagnosis of Munchausen syndrome is difficult especially during the initial assessment, although suspicion might be aroused by inconsistencies in the patient's history and discrepancies between signs and symptoms. (+info)