Insulinoma: A rare tumor of the pancreas that produces excess insulin, leading to hypoglycemia. Abdominal pain can be associated with the tumor itself or with hypoglycemic episodes. This diagnosis is considered the most likely due to the direct link between insulin overproduction and hypoglycemia, along with potential abdominal symptoms.

Diabetic Gastroparesis: In patients with diabetes, especially those with long-standing disease, gastroparesis (delayed stomach emptying) can cause abdominal pain and nausea. Hypoglycemia can occur if food is delayed in emptying from the stomach, affecting the timing of glucose absorption. This condition is a common complication in diabetes and can explain both symptoms.
Addison's Disease: Although less common, Addison's disease (primary adrenal insufficiency) can cause hypoglycemia due to the lack of cortisol, a hormone that helps regulate blood sugar levels. Abdominal pain is also a symptom, often accompanied by weight loss, fatigue, and changes in skin pigmentation.
Hypopituitarism: A condition where the pituitary gland does not produce one or more of its hormones or not enough of them. This can include ACTH (adrenocorticotropic hormone), which stimulates the adrenal glands to produce cortisol. A deficiency can lead to hypoglycemia and potentially abdominal pain among other symptoms.

Mesenteric Ischemia: A serious condition where there's a blockage in one of the major arteries that supply blood to the intestines. It can cause severe abdominal pain and, in some cases, hypoglycemia due to decreased intestinal absorption of glucose. This condition is life-threatening and requires immediate medical attention.
Sepsis: Although not directly causing hypoglycemia and abdominal pain as primary symptoms, sepsis can lead to both due to the body's systemic response to infection. Early recognition is crucial as sepsis can rapidly progress to a life-threatening condition.
Acute Pancreatitis: Inflammation of the pancreas that can cause severe abdominal pain. While not typically associated with hypoglycemia directly, in severe cases, it can lead to metabolic disturbances including hypoglycemia due to the pancreas's role in glucose regulation.

Glucagonoma: A rare tumor of the pancreas that produces excess glucagon, leading to hyperglycemia rather than hypoglycemia. However, in some cases, it can cause hypoglycemia due to the body's response to the tumor or due to the tumor's effect on pancreatic function. Abdominal pain can be a symptom.
Familial Hypoglycemia Syndromes: Rare genetic disorders that affect glucose metabolism, leading to hypoglycemia. Some of these syndromes can also cause abdominal symptoms, though they are less common and typically identified in childhood.