Factitious hyposthenuria

A patient originally thought to have intermittent pituitary diabetes insipidus and acquired Pitressin® resistance was followed for six years and restudied. The subsequent data suggest that the patient's “disease” is factitious.     

Factitious diarrhoea

Gastroenterologists often have to deal with patients with chronic diarrhoea. The vast majority will suffer from functional bowel syndrome. A few will present with a clear-cut organic disease. If chronic diarrhoea remains unexplained after extensive testing, if daily stool volume is high (greater than 500 g/24 h) and if the patient is female, factitious diarrhoea should be considered. Melanosis coli on sigmoidoscopy, cathartic colon on barium enema examination, a positive room search and chemical detection of the presence of specific laxatives in urine or stool may lead to the correct diagnosis. Treatment and management of such patients is difficult. Denial is the usual response to confrontation. Counselling and guidance by psychiatrists or psychologists is often not accepted by the patient. In many cases the role of the physician may be limited to preventing further potentially dangerous diagnostic and therapeutic interventions.     

Factitious lowering of the serum potassium level after cardiopulmonary resuscitation. Implications for evaluating the arrhythmogenicity of hypokalemia in acute myocardial infarction

Hypokalemia has been suggested as a predisposing factor to the development of fatal arrhythmias in acute myocardial infarction. Evidence cited to support this concept has been derived largely from studies in which the determination of the serum potassium level was made following a cardiac arrhythmia and/or arrest, and often following cardiopulmonary resuscitation (CPR); this postresuscitation potassium level has been considered to be representative of the prearrest value. In the patient described herein, serial determinations of serum potassium obtained fortuitously before and intentionally following sudden unexpected cardiac arrest in a hospitalized patient demonstrate that the prearrest serum potassium level cannot be inferred from electrolyte values obtained after CPR.     

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.     

Factitious methemoglobinemia.

We report the case of a 26 year-old female who was treated on numerous occasions for methemoglobinemia believed secondary to surreptitious abuse of dapsone as part of a factitious disorder.     

Factitious septic arthritis

Septic arthritis is an uncommon manifestation of factitious illness. We report 2 patients who developed septic arthritis of the knee after repeated self-administered intraarticular injections. Multiple unusual infective agents were isolated. These cases illustrate malingering and Munchausen syndrome, 2 examples from the spectrum of factitious disease syndromes.     

Factitious diabetic instability

Factitious diabetic instability is described in four patients. In three the predominant problem was recurrent hypoglycaemia. The fourth presented with apparent insulin resistance and episodes of ketoacidosis. The methods used to make the diagnosis are described, and the factors which contribute to this type of diabetic instability are discussed.     

Factitious Cushing's syndrome

A woman with pituitary-dependent Cushing's disease remained hypercortisolemic after bilateral adrenalectomy. A search for an adrenal remnant by venous catheterization study suggested persistent cortisol-secreting tissue in the left adrenal bed. During ACTH stimulation, plasma corticosterone concentrations remained low and cortisol remained high, suggesting the cortisol was of exogenous origin. Cushingoid features resolved after confronting the patient with this evidence. Plasma corticosterone concentrations played a novel role in the diagnosis of factitiously induced Cushing's syndrome in this patient.     

Factitious septic arthritis

Septic arthritis is an uncommon manifestation of factitious illness. We report 2 patients who developed septic arthritis of the knee after repeated self-administered intraarticular injections. Multiple unusual infective agents were isolated. These cases illustrate malingering and Munchausen syndrome, 2 examples from the spectrum of factitious disease syndromes.