Differential Diagnosis for Recurrent Hypoglycemia

Single Most Likely Diagnosis

• Insulinoma: A rare tumor of the pancreas that produces excess insulin, leading to episodes of hypoglycemia. This condition is often considered first due to its direct link with insulin overproduction and the resulting hypoglycemic episodes.

Other Likely Diagnoses

• Type 1 Diabetes with Excessive Insulin Administration: Individuals with type 1 diabetes who take too much insulin can experience recurrent hypoglycemia. This is a common issue due to the fine balance required in insulin dosing.
• Type 2 Diabetes with Certain Medications: Certain oral medications for type 2 diabetes, such as sulfonylureas, can cause hypoglycemia by stimulating insulin release from the pancreas.
• Alcohol Abuse: Alcohol can cause hypoglycemia by inhibiting gluconeogenesis in the liver. Individuals who consume alcohol in excess are at risk, especially if they have not eaten recently.
• Liver Disease: Conditions like liver cirrhosis can lead to hypoglycemia due to the liver's impaired ability to store and release glucose.

Do Not Miss Diagnoses

• Adrenal Insufficiency: Although less common, adrenal insufficiency (including Addison's disease) can lead to hypoglycemia due to the lack of cortisol, a hormone that helps regulate blood sugar levels. Missing this diagnosis can be fatal.
• Pituitary Adenoma: Certain tumors of the pituitary gland can lead to deficiencies in hormones that regulate blood sugar, potentially causing hypoglycemia. Early detection is crucial for effective management.
• Hypopituitarism: A condition characterized by the underproduction of hormones by the pituitary gland, which can include growth hormone and adrenocorticotropic hormone (ACTH) deficiencies, leading to hypoglycemia.

Rare Diagnoses

• Glycogen Storage Diseases: Genetic disorders that affect the body's ability to store and release glucose from glycogen, leading to episodes of hypoglycemia.
• Glucagon Deficiency: A rare condition where the pancreas does not produce enough glucagon, a hormone that raises blood glucose levels.
• Congenital Hyperinsulinism: A rare genetic disorder that causes the pancreas to produce too much insulin, leading to severe hypoglycemia, often in infancy.
• Factitious Hypoglycemia: Self-induced hypoglycemia, often seen in individuals with a history of factitious disorder or Munchausen syndrome, where they deliberately take insulin or oral hypoglycemic agents to induce hypoglycemia.