From the Research
CT scans of the brain, chest, abdomen, or pelvis are not routinely indicated in the initial workup for hypoglycemia. The initial evaluation should focus on laboratory tests including plasma glucose, insulin, C-peptide, proinsulin, beta-hydroxybutyrate, and sulfonylurea levels during a hypoglycemic episode (ideally when blood glucose is below 55 mg/dL) 1. A thorough history, physical examination, and these laboratory tests are usually sufficient to determine the cause of hypoglycemia, whether it's medication-induced, related to insulinoma, or due to other endocrine disorders.
Imaging studies like CT scans are only considered after initial biochemical testing suggests a specific cause that requires anatomical evaluation, such as suspected insulinoma or other pancreatic tumors 1. In these cases, abdominal imaging would be targeted to the pancreas rather than performed as a general screening tool. Brain imaging is only indicated if neurological symptoms persist after correction of hypoglycemia, suggesting another neurological process.
The diagnostic approach to hypoglycemia should begin with the Whipple triad, which includes low levels of plasma glucose, signs or symptoms that would be expected with low levels of plasma glucose, and improvement in those signs or symptoms when the level of plasma glucose increases 1. This approach is more cost-effective and prevents unnecessary radiation exposure from CT scans that are unlikely to contribute to the diagnosis in most cases of hypoglycemia.
Key points to consider in the workup of hypoglycemia include: