Difficultés d'interprétation en toxicologie : identification plasmatique de sulfamides hypoglycémiants et hypoglycémies inexpliquées

Hypoglycemia crisis of unknown origin can be induced by factitious sulfonylurea ingestion which as been described as Munchausen syndrom. It is essentiel to distinguish from an insulin-secreting tumor, and diagnostic can be done by using a method for identification of sulfonylureas in human plasma. Different analytical techniques have been used : most methods are based on HPLC with ultra-violet, or diode array which is more specific. More recently, highly selective liquid chromatography-electrospray tandem mass spectrometry (MS-MS) has been described for rapid screening. We report the case of hypoglycemic crises in a 38 years old woman. HPLC-DAD was used after liquid/liquid extraction of plasma and urine samples. Identification of gliclazide was done in three plasma samples but not in urine. This HPLC-DAD assay can be highly convenient but need plasma sampling at a time period closed from hypoglycemic crise.