Differential Diagnosis for Persistent Hypoglycemia
Single Most Likely Diagnosis
- Insulinoma: A rare tumor of the pancreas that produces excess insulin, leading to hypoglycemia. It is a common cause of persistent hypoglycemia due to endogenous hyperinsulinism.
Other Likely Diagnoses
- Type 1 Diabetes with Excess Insulin Administration: Overdosing on insulin can lead to persistent hypoglycemia in patients with type 1 diabetes.
- Hepatic Failure: The liver plays a crucial role in glucose metabolism. Liver failure can lead to an inability to release glucose into the bloodstream, causing hypoglycemia.
- Renal Failure: Similar to hepatic failure, renal failure can affect glucose metabolism and lead to hypoglycemia, especially in patients with diabetes.
- Adrenal Insufficiency: The adrenal glands produce hormones like cortisol, which help regulate blood sugar. A deficiency in these hormones can lead to hypoglycemia.
Do Not Miss Diagnoses
- Factitious Hypoglycemia: Self-administration of insulin or oral hypoglycemic agents, which can be life-threatening if not recognized.
- Pituitary Adrenal Axis Suppression: Long-term use of corticosteroids can suppress the body's natural production of cortisol, leading to hypoglycemia when the steroids are stopped.
- Malignancy: Certain tumors can produce insulin-like growth factor II (IGF-II), leading to hypoglycemia.
Rare Diagnoses
- Glycogen Storage Diseases: Genetic disorders that affect the body's ability to store and release glucose from glycogen.
- Glucose-6-Phosphatase Deficiency (Von Gierke's Disease): A rare genetic disorder affecting glucose metabolism.
- Congenital Hyperinsulinism: A rare condition where the pancreas produces too much insulin from birth.
- Autoimmune Hypoglycemia: A rare condition where the body produces antibodies against insulin or the insulin receptor, leading to hypoglycemia.