{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T14:48:53Z","timestamp":1791557333738,"version":"4.3.4"},"reference-count":16,"publisher":"American Academy of Pediatrics (AAP)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2015,11,1]]},"abstract":"<jats:p>The recognition of fabricated illness (FI) in a child represents a diagnostic challenge. The suspicion of FI often arises from the discrepancy between laboratory tests and clinical history. For instance, (unnecessary) insulin injections by caregivers has been widely described as a common cause of factitious hypoglycemia that may be inferred from discrepancies between plasma insulin and c-peptide. However, contemporary administration of insulin with an insulin secretagogue (glyburide), and of additional drugs, can make the diagnostic pathway problematic. We report the case of a child 4 years and 11 months old, admitted for alternance of hypo- and hyperglycemia associated with hirsutism, hypokalemia, nephrocalcinosis, and neurodevelopmental delay. All these features were compatible with Rabson-Mendenhall syndrome, a rare disorder of severe insulin resistance linked to mutations of insulin receptor. At admission, plasma insulin levels were high during hypoglycemic episodes, but c-peptide was repeatedly in the normal range. The genetic analysis of insulin receptor was negative. The story of previous hospital admissions, inconsistency between insulin and c-peptide values, and association between hypoglycemic episodes in the child with the presence of the mother, raised the suspicion of FI. This hypothesis was confirmed by a video recording that revealed the administration by the mother of multiple drugs (insulin, glyburide, progesterone, and furosemide) that mimicked most of the features of Rabson-Mendenhall syndrome, including hirsutism and hypoglycemia with coincident, inappropriately normal c-peptide values due to the administration of the insulin secretagogue. Our case indicates that inconsistency among consecutive diagnostic tests should be regarded as a clue of FI.<\/jats:p>","DOI":"10.1542\/peds.2014-4165","type":"journal-article","created":{"date-parts":[[2015,10,6]],"date-time":"2015-10-06T00:38:31Z","timestamp":1444091911000},"page":"e1361-e1365","source":"Crossref","is-referenced-by-count":14,"title":["Case Report: When an Induced Illness Looks Like a Rare Disease"],"prefix":"10.1542","volume":"136","author":[{"given":"Ivana","family":"Rabbone","sequence":"first","affiliation":[{"name":"Department of Pediatrics, University of Turin, Turin, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alfonso","family":"Galderisi","sequence":"additional","affiliation":[{"name":"Department of Women and Children\u2019s Health, University of Padua, Padua, Italy;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Davide","family":"Tinti","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, 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