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PubMed1998

Factitious illness by proxy presenting as anorexia and polydipsia by proxy.

Factitious illness by proxy is a highly pathological form of parent-child relationship. To our knowledge no former case of polydipsia by proxy has been published. The case of a 2-y-old boy suffering from malnutrition due to displacement of maternal anorexia and polydipsia is presented. Child psychiatric evaluation found cognitive delay and psycho-social impairment in the child, as well as a severe mother-child relationship disturbance. Psychological assessment showed a personality disorder with depressive and paranoid features in the mother. The father was described as a schizoid personality. The possible mechanisms of displacement are hypothesized.

Anorexia↗
PubMed1981

Sudden death associated with thyroid hormone abuse.

Three patients with hyperthyroidism due to deliberate intake of excessive amounts of L-thyroxine are described wherein death was "instantaneous" and presumably due to ventricular fibrillation. Hyperthyroidism was not recognized on admission in two of these patients because of atypical presentations. Autopsy was performed in two patients. In one patient no coronary disease was present and focal myocarditis with leukocytic infiltration was noted. The second patient had an acute posterior myocardial infarction due to acute coronary thrombosis, but focal areas of leukocytic infiltration and fibrosis were also seen in the anterior wall not involved in the process of infarction. Factitious hyperthyroidism due to L-thyroxine abuse can be associated with sudden death in the absence of coronary artery disease and may be related to a drug induced myocarditis.

Adult↗
PubMedDate not supplied

Hyperthyroidism: multiple possibilities in the female patient.

Hyperthyroidism is a clinical syndrome characterized by an excess of thyroid hormone, and its clinical consequences. A suppressed serum TSH concentration is the earliest biochemical manifestation of hyperthyroidism. Subclinical hyperthyroidism, characterized by suppressed serum TSH concentration alone, has important clinical consequences. These include bone loss in postmenopausal women and atrial fibrillation. A twenty-four hour radioiodine uptake and radionuclide scan are indispensable in the differential diagnosis of hyperthyroidism. Graves' Disease, an autoimmune disorder, demonstrates a strong female prevalence; the twenty-four hour radioiodine uptake is normal or elevated. Therapeutic options, including anti-thyroid drugs, radioactive iodine (131I) and surgery are utilized in all age groups. These include use in women during the reproductive years. Toxic nodular goiter and "hot" nodules are less common forms of hyperthyroidism; these too have normal or elevated radioiodine uptake, with characteristic radionuclide scans. Hyperthyroidism with a near-zero radioiodine uptake also has important clinical implications. Factitious (exogenous) hyperthyroidism is characterized by a low serum thyroglobulin concentration. Treatment consists of decreasing the dosage of, or withdrawing, thyroid hormone. Painful subacute thyroiditis, a post-vital syndrome, causes spontaneously resolving hyperthyroidism, which is often followed by hypothyroidism. The most common cause of hyperthyroidism with a low radioiodine uptake is painless, lymphocytic subacute thyroiditis. Here too, hyperthyroidism spontaneously resolves and often passes through a hypothyroid phase. This phase often requires therapy, and permanent mild or severe hypothyroidism may result.

Chorionic Gonadotropin↗
PubMed1998

A bridge over troubled water...mixed water and electrolyte disorders.

Plasma volume, nitrogenous wastes in the plasma, and plasma osmolality profoundly affect the function of various organs in the body, particularly the central nervous system and the heart. Some parameters are more critical for these organs than others, so that, when homeostatic mechanisms come into play, the body often defends the parameter of greatest importance at the expense of others. The hyponatremia and azotemia that develop in dehydrated infants exemplify this prioritization of the body. The primary goal of therapeutic intervention in such circumstances is, therefore, geared toward a correction of dehydration. While alterations in plasma and urinary electrolyte patterns commonly reflect adjustments made by the body's machinery, it is essential at the bedside to identify factitiously abnormal laboratory results produced by laboratory analytical machines. They measure not only biologically active but also insignificant components of plasma electrolytes and osmolality.

Child↗
PubMed1983

[Factitious hyperthyroidism caused by L-thyroxin abuse. Case report].

A 43 years old female was treated for 8 months with antithyroid drugs because of a difficult adjustable hyperthyroidism. In spite of this massive antithyroid therapy a threatening deterioration of the clinical picture occurred. The reason for it was the secret intermittent intake of up to 1200 micrograms lT4 daily motivated by private problems. The difficulties of a differential diagnosis between a thyrotoxicosis factitia and an endogenous hyperthyroidism is stressed. One should always consider a thyrotoxicosis factitia in the case of suggestion of a psychopathia and when thyroid hormone medication is used for suppressive thyroid hormone therapy or as a prophylaxis of goiter recurrence. In addition overweight, major personality disorders and resistance to antithyroid drugs are indicative for thyroid hormone abuse. Important indicators for the differentiation between a thyroid hormone abuse and an endogenous hyperthyroidism are a lack of technetium- or radioiodine-uptake in the thyroid and suppressed levels of thyroglobulin.

Female↗
PubMed1979

Surreptitious use of warfarin.

The authors present the case of a 61-year-old woman who became increasingly sensitive to her warfarin. When she remained anticoagulated during a 2-month period off of warfarin a plasma analysis detected warfarin indicating she was taking the anticoagulant surreptitiously. This patient demonstrated features of factitious illness including a background of unsatisfactory childhood relationships, average intelligence, a lack of psychosis, and no obvious secondary gain. Surreptitious use of anticoagulants should be considered in all cases of unexplained hemorrhagic symptoms with low prothrombin activity.

Denial, Psychological↗
PubMedDate not supplied

Scintigraphic manifestations of thyrotoxicosis.

The term thyrotoxicosis refers to the clinical syndrome of increased systemic metabolism that results when the serum concentrations of free thyroxine, free triiodothyronine, or both are elevated. The term hyperthyroidism refers to overactivity of the thyroid gland with a resultant increase in thyroid hormone synthesis and release into the systemic circulation. These terms are not interchangeable, since thyrotoxicosis can develop in thyroid conditions that are not associated with increased thyroid function, such as thyroiditis, or in so-called factitious hyperthyroidism. The clinical signs and symptoms of thyrotoxicosis are virtually identical regardless of the cause. However, in a given patient, every attempt should be made to determine the exact cause of the thyrotoxicosis, as this in turn determines the prognosis and treatment. Since thyroid scintigraphy demonstrates the functional state of the thyroid gland, it should be used, in conjunction with determination of radioactive iodine uptake, as the imaging modality of choice for diagnosis of thyrotoxicosis. Although the scintigraphic features of several of the thyroid disorders that cause thyrotoxicosis may overlap, their recognition helps narrow the differential diagnosis, thereby guiding the referring physician in the work-up and management of this disorder.

Adult↗
PubMed1990

Neuropsychology and malingering: comment on Faust, Hart, and Guilmette (1988)

Faust, Hart, and Guilmette (1988) recently reported on the inability of neuropsychologists to detect malingering in children who were asked to "fake bad" on a battery of neuropsychological measures. Because of methodological issues, implications of their research are not generalizable to the actual clinical setting. Limitations of the questionnaire format in detecting factitious results are discussed along with the inherent bias of such a research design to overinterpret pathology. The competency of the clinical neuropsychologist judges and their selection process are questioned. Last, some guidelines are offered for future research dealing with the issue of detection of malingering in neuropsychological practice.

Child↗
PubMed2001

Panniculitis. Part II. Mostly lobular panniculitis.

UNLABELLED: The second part of our review of panniculitis summarizes the clinicopathologic features of the mostly lobular panniculitides. Erythema induratum of Bazin (nodular vasculitis) represents the most common variant of lobular panniculitis with vasculitis, although controversy persists about the nature of the involved vessels. Mostly lobular panniculitides without vasculitis comprise a series of disparate disorders. These include sclerosing panniculitis that results from chronic venous insufficiency of the lower extremities; panniculitis with calcification of the vessel walls such as calciphylaxis and oxalosis; and inflammatory diseases with crystals within the adipocytes such as sclerema neonatorum, subcutaneous fat necrosis of the newborn, and poststeroid panniculitis. Connective tissue diseases, such as systemic lupus erythematosus and dermatomyositis, pancreatic diseases, and alpha(1)-antitrypsin deficiency may also show a mostly lobular panniculitis with characteristic histopathologic features. Lobular panniculitis may also be an expression of infections, trauma, or factitial causes involving the subcutaneous fat. Lipoatrophy refers to a loss of subcutaneous fat due to a previous inflammatory process involving the subcutis, and it may be the late-stage lesion of several types of panniculitis. In contrast, lipodystrophy means an absence of subcutaneous fat with no evidence of inflammation and often the process is associated with endocrinologic, metabolic, or autoimmune diseases. Finally, cytophagic histiocytic panniculitis is the term that has been used to describe two different processes: one is inflammatory, a lobular panniculitis, and the other one is neoplastic, a subcutaneous T-cell lymphoma. The only common feature of these two different processes is the presence of cytophagocytosis in the lesions. (J Am Acad Dermatol 2001;45:325-61.) LEARNING OBJECTIVE: At the completion of this learning activity, participants should be familiar with the pathogenesis, clinical manifestations, histopathologic findings, and treatment options for the most frequent variants of the lobular panniculitides.

Humans↗
PubMed1975

Factitial mesenteric avulsion.

Colon exteriorization procedures were done in two patients who also were, or became, psychotic. Each patient pulled on the exteriorized loop, causing severe bowel injury. In known or potential psychotics some other form of colonic injury management--other than exteriorization--should be utilized, or extreme caution should be taken to prevent inadvertent self-injury by the patient.

Adult↗
PubMedDate not supplied

Factitial Weber-Christian disease: a case report.

A 28 yr old white woman with fevers, arthralgias, and panniculitis was found to have factitial Weber-Christian disease induced by repeated subcutaneous injections of paint. The characteristics of self-induced dermatoses, various agents used in their production, and the psychodynamics of patients with self-induced illnesses are discussed. It is important that this diagnostic possibility be considered in patients presenting with obscure constitutional, musculoskeletal, and cutaneous findings.

Adult↗
PubMed1977

Fever: genuine or factitious?

Although patients with factitious fever form a small subgroup of all patients investigated for fever of unknown origin, the diagnosis should be kept in mind. If unsuspected, this phenomenon can lead to a multiplicity of laboratory investigations and misuse of hospital beds, as well as to unnecessary risk to the patient.

Adolescent↗
PubMed1981

Hypoglycemia secondary to factitious hyperinsulinism.

The case is reported of a young woman with spontaneous hypoglycemia due to fractions hyperinsulinism. Hyperinsulinism was established as the cause by the fact that the level of immunoreactive insulin was significantly elevated and inappropriate for the hypoglycemia. Exogenous insulin injection was implicated on the basis of the finding that serum C-peptide was suppressed. The patient later admitted injecting insulin and was discharged under psychiatric care.

Adult↗
PubMed1991

Chronic wounds and delusions of parasitosis in the drug abuser.

Plastic surgeons are routinely consulted about the care of difficult or chronic wounds. Most of these wounds have a physiologic basis and are treated according to basic wound-healing principles. Patients with factitious wounds are difficult to treat and present diagnostic dilemmas. We present a case and review of the literature of drug-induced delusions of parasitosis to inform plastic surgeons of this important entity and for consideration in the differential diagnosis of chronic wounds.

Adult↗
PubMed1986

Factitious Cushing's syndrome.

In this report we describe a patient who produced the clinical and laboratory features of Cushing's syndrome by injecting himself for many months with hydrocortisone. Factitious Cushing's syndrome is a variant of the Münchausen syndrome and should be considered if tests used to establish the diagnosis of Cushing's syndrome appear incongruous particularly in subjects with access to medical intelligence and drugs.

Adult↗
PubMed1985

The Munchausen patient in a forensic facility.

The many reports in the literature of chronic factitious illness (Munchausen's Syndrome) have emphasized the difficulty of treating these patients because of their propensity to leave medical facilities as soon as the factitious nature of their symptoms is discovered, and because of their disinclination to accept psychiatric help. The authors report on their treatment of such a patient who was incarcerated for over ten years under a criminal commitment, and discuss methods for overcoming resistances to treatment in Munchausen's patients.

Adult↗
PubMed1975

Plasma C-peptide and diagnosis of factitious hyperinsulinism. Study of an insulin-dependent diabetic patient with "spontaneous" hypoglycemia.

Factitious hyperinsulinism was suspected in a patient with an 11-year history of insulin-dependent, ketosis-prone diabetes mellitus who began to experience repetitive episodes of "spontaneous" hypoglycemia. Insulin mediation of the hypoglycemia was confirmed by documenting that urinary insulin and total extractable insulin in plasma increased during periods of hypoglycemia. Failure to detect significant amounts of human C-peptide by radioimmunoassay during periods of hypoglycemia or in response to stimulation with glucagon, leucine, or tolbutamide indicated that the insulin was not endogenous. The diagnosis of factitious hyperinsulinism was ultimately proved by the finding of radioactivity in the patient's urine after 131-I Hippuran was added to a vial of insulin found in the patient's room.

Diabetes Mellitus↗
PubMed2004

Cardiopathia fantastica: the cardiac variant of Munchausen syndrome.

Munchausen syndrome is a rare condition in which the patient repeatedly seeks medical care for factitious illnesses. Cardiac Munchausen syndrome was first reported in 1953 and later referred to as cardiopathia fantastica. It is characterized by clinical manifestations of acute cardiac disease that are feigned and recurrent. Cardiopathia fantastica can have a variety of presentations similar to true cardiac disease. Most cases have presented with chest pain simulating acute coronary artery disease, but arrhythmias, hypertensive crises, abnormal biochemistry, and electrocardiographic findings have also been noted. These patients are willing to undergo expensive, invasive, and risky procedures to evaluate their simulated illness. This condition is likely to be significantly underreported. In some patients, the presence of abnormal findings that are clinically insignificant may complicate the investigative approach. Patients with this disorder consume a disproportionate amount of health care dollars and sometimes are left with residual deficits as complications of invasive procedures. In this review, we discuss the recognition, manifestations, and treatment of cardiopathia fantastica.

Arrhythmias, Cardiac↗