Differential Diagnosis for an 8-Year-Old Boy with Various Symptoms

Single Most Likely Diagnosis

• Adrenal Insufficiency (Addison's Disease): This condition is characterized by the adrenal glands not producing enough cortisol and aldosterone. The symptoms of hypoglycemia, salt cravings, and frequent urination could be indicative of this condition. Additionally, children with Addison's disease may exhibit behavioral issues that could be mistaken for ADHD.

Other Likely Diagnoses

• Type 1 Diabetes: Although the blood glucose levels mentioned are not typically high enough to suggest uncontrolled diabetes, the occasional hypoglycemia and frequent urination could be related to diabetes. However, the presence of salt cravings is less typical.
• Growth Hormone Deficiency: This condition can lead to hypoglycemia, especially in children, and might also contribute to behavioral issues or difficulties that could be confused with ADHD.
• Autonomic Dysfunction: This could explain the frequent nighttime urination and possibly the hydration issues, though it's less directly linked to hypoglycemia or salt cravings.

Do Not Miss Diagnoses

• Pheochromocytoma: A rare tumor of the adrenal gland that could cause episodic hypoglycemia, among other symptoms like hypertension and sweating. Although rare, missing this diagnosis could be catastrophic.
• Congenital Adrenal Hyperplasia (CAH): Certain forms of CAH can lead to deficiencies in cortisol and aldosterone production, similar to Addison's disease, and could present with hypoglycemia and salt cravings.
• Hypopituitarism: A condition where the pituitary gland does not produce one or more of its hormones, or not enough of them. This could lead to a variety of symptoms including growth hormone deficiency, which might explain some of the boy's symptoms.

Rare Diagnoses

• Familial Dysautonomia (Riley-Day Syndrome): A rare genetic disorder that affects the development of the autonomic nervous system, leading to a variety of symptoms including dysregulation of blood glucose levels.
• Leptin Deficiency: A condition that affects appetite regulation and could potentially lead to some of the metabolic symptoms described, though it's extremely rare and typically associated with severe obesity.
• Glucagon Deficiency: A rare condition that could lead to hypoglycemia, though it's less likely to explain all the symptoms presented.