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Repaglinide-Induced Factitious Hypoglycemia

Division of Intramural Research, National Institute of Diabetes, Digestive and Kidney Diseases (B.H., M.C.S., P.G.), and Departments of Pharmacy (F.P.) and Clinical Pathology (G.C.), W. G. Magnuson Clinical Center, National Institutes of Health, Bethesda, Maryland 20892; and Laurel Endocrine Associates (R.B.), Columbia, South Carolina 29204

Address correspondence and requests for reprints to: Phillip Gorden, M.D., NIDDK Director, National Institutes of Health, Building 10, Room 8S235, Bethesda, Maryland 20892.

We report the first case of repaglinide-induced factitious hypoglycemia in a young male. This case posed a challenging diagnostic dilemma because commercial assays for repaglinide are not available. Furthermore, the patient had a series of positive diagnostic tests such as high proinsulin and localizing intra-arterial calcium stimulation suggestive of insulinoma. This case, again, demonstrates the importance of pure clinical judgment in the face of often-conflicting laboratory data in making a correct diagnosis and the requirement of definitive data for an appropriate therapeutic resolution.

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