Adult Hypoglycemic Differential Diagnosis
The following is a differential diagnosis for adult hypoglycemia, categorized for clarity and emphasis on critical conditions.
Single Most Likely Diagnosis
- Medication-induced hypoglycemia: This is often the most common cause of hypoglycemia in adults, particularly in those with diabetes mellitus who are taking insulin or oral hypoglycemic agents. The risk is heightened with certain medications, dosing errors, or changes in diet and physical activity.
Other Likely Diagnoses
- Insulinoma: A rare tumor of the pancreas that produces excess insulin, leading to hypoglycemia. It's more common in adults and can be suspected in cases of recurrent, severe hypoglycemia without an obvious cause.
- Alcohol-induced hypoglycemia: Alcohol can cause hypoglycemia by inhibiting gluconeogenesis in the liver. This is particularly seen in individuals who binge drink without eating.
- Hypopituitarism: A condition where the pituitary gland does not produce one or more of its hormones, or not enough of them. This can lead to adrenal insufficiency, which may cause hypoglycemia.
- Adrenal insufficiency: The adrenal glands not producing enough cortisol and, in some cases, aldosterone. This can lead to hypoglycemia, among other symptoms.
Do Not Miss Diagnoses
- Septic shock: Although not typically the first consideration for hypoglycemia, septic shock can cause hypoglycemia due to increased glucose consumption by the body and impaired glucose production. Missing this diagnosis can be fatal.
- Meningitis or encephalitis: Infections of the central nervous system can lead to hypoglycemia, possibly due to inflammation affecting glucose metabolism or due to associated sepsis.
- Acute liver failure: The liver plays a crucial role in glucose metabolism. Acute liver failure can lead to hypoglycemia due to the liver's inability to store or release glucose.
Rare Diagnoses
- Gastric bypass surgery complications: Certain types of gastric bypass surgery can lead to hypoglycemia due to changes in glucose and insulin dynamics.
- Non-islet cell tumor hypoglycemia (NICTH): Rare tumors that can produce insulin-like growth factor II (IGF-II), leading to hypoglycemia.
- Congenital disorders of glycosylation: Rare genetic disorders affecting the body's ability to glycosylate proteins, which can lead to hypoglycemia among other symptoms.
- Autoimmune hypoglycemia: A rare condition where the body produces antibodies against insulin or the insulin receptor, leading to hypoglycemia.