Review Question - QID 213705

A 24-year-old woman presents to the emergency department after she collapsed at work. She is a home care nurse for elderly patients and was found by a client to be slumped over in the bathroom. Her past medical history is significant for major depressive disorder for which she takes fluoxetine. She also has a history of chronic pain in multiple locations without clear etiology despite extensive evaluation. On presentation, she is found to be a very thin anxious appearing woman who says that she started feeling shaky and diaphoretic right before passing out. Urine toxicology reveals positive cannabinoids as well as opioids but is otherwise negative for amphetamines, benzodiazepines, cocaine, phencyclidine, sulfonylureas, meglitinides, and methadone. Serum studies reveal an elevated C-peptide level. Which of the following is most likely etiology for this patient's symptoms?