Abstract：
BACKGROUND: Inappropriately high levels of insulin secretion can cause the potentially fatal condition of persistent hyperinsulinemic hypoglycemia of infancy. Our paper focuses on another cause of severe hypoglycemia, which can be easily missed.
METHODS: An 18-month-old Saudi female was referred to our hospital for further investigation and management of her recurrent hypoglycemic attacks as a case of persistent hyperinsulinemic hypoglycemia of infancy. During admission, we noticed multiple red flags from the history; the mother was insisting on a pancreatectomy, rather than going for a positron emission tomography scan, and most importantly, all hypoglycemic attacks occurred while the mother was around. Consequently, after further investigation, the case was diagnosed as a caregiver-fabricated illness, and the case was referred to the Child Protection Center.
CONCLUSIONS: One must have a high index of suspicion to diagnose caregiver-fabricated illness. Physicians should be more attentive to prevent such a disease, which could eventually become lethal if left unnoticed.
METHODS: An 18-month-old Saudi female was referred to our hospital for further investigation and management of her recurrent hypoglycemic attacks as a case of persistent hyperinsulinemic hypoglycemia of infancy. During admission, we noticed multiple red flags from the history; the mother was insisting on a pancreatectomy, rather than going for a positron emission tomography scan, and most importantly, all hypoglycemic attacks occurred while the mother was around. Consequently, after further investigation, the case was diagnosed as a caregiver-fabricated illness, and the case was referred to the Child Protection Center.
CONCLUSIONS: One must have a high index of suspicion to diagnose caregiver-fabricated illness. Physicians should be more attentive to prevent such a disease, which could eventually become lethal if left unnoticed.
摘要：
背景：不适当的高水平胰岛素分泌可导致婴儿期持续性高胰岛素血症性低血糖的潜在致命性状况。我们的论文集中在严重低血糖的另一个原因，这很容易错过。
方法：一名18个月大的沙特女性因婴儿期持续性高胰岛素血症性低血糖而被转诊到我们医院进行进一步的调查和治疗。入院期间,我们注意到历史上的多个危险信号母亲坚持做胰腺切除术,而不是去正电子发射断层扫描，最重要的是,所有低血糖发作都发生在母亲在身边时.因此,经过进一步调查,该病例被诊断为照顾者捏造的疾病，案件被移交给了儿童保护中心.
结论：必须有高度的怀疑指数才能诊断照顾者制造的疾病。医生应该更加注意预防这种疾病，如果不引起注意，最终可能会致命。
方法：一名18个月大的沙特女性因婴儿期持续性高胰岛素血症性低血糖而被转诊到我们医院进行进一步的调查和治疗。入院期间,我们注意到历史上的多个危险信号母亲坚持做胰腺切除术,而不是去正电子发射断层扫描，最重要的是,所有低血糖发作都发生在母亲在身边时.因此,经过进一步调查,该病例被诊断为照顾者捏造的疾病，案件被移交给了儿童保护中心.
结论：必须有高度的怀疑指数才能诊断照顾者制造的疾病。医生应该更加注意预防这种疾病，如果不引起注意，最终可能会致命。
