Longitudinal Treatment of a Case of Panhypopituitarism, Pseudotumor Cerebri, and (Ultimately) Factitious (Munchhausen’s) Disorder by Proxy

Abstract

This case narrative written in collaboration with the patient's treating pediatrician presents a very complex patient with early onset panhypopituitarism, migraine, pseudotumor cerebri, the latter leading to the need for neurosurgery. The patient’s diagnosed psychiatric comorbidity, while difficult to parsimoniously classify, included elements of depression, anxiety, psychosis, and "intolerable" pain. Such a case is already profoundly complex, but adding to the challenges in this case is classic Munchhausen’s syndrome (factitious disorder) by proxy, with the patient's parent, in this case his mother, (as is often the case) as the perpetrator. Eventual intervention by child protective services (CPS) to remove his mother from his care and place him with his father resulted in significant improvement in the patient’s functioning, reports of fewer physical complaints, and improved performance in social and academic roles